Healthcare Provider Details

I. General information

NPI: 1992782510
Provider Name (Legal Business Name): LUIS ANTONIO BRENNER L.C.S.W., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 MADISON AVE SUITE F
INDIANAPOLIS IN
46227-5267
US

IV. Provider business mailing address

PO BOX 7051
GREENWOOD IN
46142-6421
US

V. Phone/Fax

Practice location:
  • Phone: 317-791-1171
  • Fax: 317-791-1303
Mailing address:
  • Phone: 317-791-1171
  • Fax: 317-791-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003325A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000078A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: