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General NPI Number Information
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NPI Number | 1225186646
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Entity Type | Organization
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Legal Business Name | MS BRENNER CLIN PSYCH PC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 255 W 88 ST
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City | NEW YORK
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State | NY
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Zip | 10024
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Country | US
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Telephone | 212-873-9440
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Fax | 212-877-9709
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Provider Business Mailing Address
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Address Line | 255 W 88 ST
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City | NEW YORK
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State | NY
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Zip | 10024
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Country | US
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Telephone | 212-873-9440
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Fax | 212-877-9709
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Authorized Official
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Title or Position | SECTY TREASURER
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Name | DR. MARCIA BRENNER
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Credential | EDD
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Telephone | 212-873-6881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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