Healthcare Provider Details

I. General information

NPI: 1194986133
Provider Name (Legal Business Name): MISS MELISSA B BRENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CARVER SQUARE BLVD FL 2
CARVER MA
02330-1200
US

IV. Provider business mailing address

4 SOUTH ST
PLYMOUTH MA
02360-2956
US

V. Phone/Fax

Practice location:
  • Phone: 774-451-3453
  • Fax: 508-747-1402
Mailing address:
  • Phone: 774-451-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: