Healthcare Provider Details

I. General information

NPI: 1366467144
Provider Name (Legal Business Name): MARCY BRENNER MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 N 3RD ST
HARRISBURG PA
17110-1308
US

IV. Provider business mailing address

1215 ROBERTS VALLEY RD
HARRISBURG PA
17110-1765
US

V. Phone/Fax

Practice location:
  • Phone: 717-234-3839
  • Fax: 717-234-6247
Mailing address:
  • Phone: 717-599-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002671
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: