Healthcare Provider Details

I. General information

NPI: 1871423269
Provider Name (Legal Business Name): ASHLEY BRENNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 STONEBRIDGE RD
LOWER GWYNEDD PA
19002-2034
US

IV. Provider business mailing address

1004 STONEBRIDGE RD
LOWER GWYNEDD PA
19002-2034
US

V. Phone/Fax

Practice location:
  • Phone: 215-285-1009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC013494
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: