Healthcare Provider Details

I. General information

NPI: 1770496929
Provider Name (Legal Business Name): ABIGAIL BRENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRADFORD COMMONS LN
BRAINTREE MA
02184-8258
US

IV. Provider business mailing address

109 BRADFORD COMMONS LN
BRAINTREE MA
02184-8258
US

V. Phone/Fax

Practice location:
  • Phone: 781-473-4057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW2140612
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: