Healthcare Provider Details

I. General information

NPI: 1750634796
Provider Name (Legal Business Name): RACHEL ELIZABETH BRENNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MILL ST
FESTUS MO
63028-1816
US

IV. Provider business mailing address

343 S KIRKWOOD RD SUITE 200
KIRKWOOD MO
63122-4015
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 314-206-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2022015148
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: