Healthcare Provider Details

I. General information

NPI: 1972758639
Provider Name (Legal Business Name): ADRIANNE M BRENNAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2008
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 METAIRIE RD STE 615
METAIRIE LA
70005-4326
US

IV. Provider business mailing address

433 METAIRIE RD STE 615
METAIRIE LA
70005-4326
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 504-833-6730
  • Fax: 504-833-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number216
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: