Healthcare Provider Details

I. General information

NPI: 1083016067
Provider Name (Legal Business Name): DANA BRENNAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2014
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 S GOVERNORS AVE STE A
DOVER DE
19904-4800
US

IV. Provider business mailing address

43 W REDBROOK PL
SMYRNA DE
19977-3934
US

V. Phone/Fax

Practice location:
  • Phone: 302-257-3135
  • Fax: 302-526-2410
Mailing address:
  • Phone: 516-457-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001322
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: