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General NPI Number Information
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NPI Number | 1124394671
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Entity Type | Individual
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Provider Name | SUSAN HARTMAN BRENIZER M.A., LMFT (LICENSED
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 7000 E GENESEE ST LYNDON OFFICE PARK, BLDG. A SECOND FLOOR (UPPER LEVEL)
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City | FAYETTEVILLE
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State | NY
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Zip | 13066
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Country | US
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Telephone | 315-446-9646
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Fax | 315-637-6264
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Provider Business Mailing Address
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Address Line | 7000 E GENESEE ST LYNDON OFFICE PARK, BLDG. A SECOND FLOOR (UPPER LEVEL)
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City | FAYETTEVILLE
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State | NY
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Zip | 13066
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Country | US
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Telephone | 315-446-9646
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Fax | 315-637-6264
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | NYSTATE#000-425
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License Number State | NY
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