Healthcare Provider Details

I. General information

NPI: 1992868293
Provider Name (Legal Business Name): JENNIFER KERINA BRENNAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 BELMONT ST. WORCESTER RECOVERY CENTER AND HOSPITAL
WORCESTER MA
01604
US

IV. Provider business mailing address

PO BOX 552
TEMPLETON MA
01468-0552
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3506
  • Fax:
Mailing address:
  • Phone: 781-572-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118463
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: