Healthcare Provider Details

I. General information

NPI: 1942425293
Provider Name (Legal Business Name): KAREN B BRENNER LICSW, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BEACON ST
BROOKLINE MA
02446-4816
US

IV. Provider business mailing address

27 THE LEDGES RD
NEWTON MA
02459-2072
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • Fax:
Mailing address:
  • Phone: 617-244-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113696
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: