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General NPI Number Information
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NPI Number | 1619000924
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Entity Type | Individual
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Provider Name | ELLEN MERRI BRENNER LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10 UNION AVE
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City | LYNBROOK
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State | NY
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Zip | 11563-3397
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Country | US
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Telephone | 516-593-8408
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Fax | 516-887-9436
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Provider Business Mailing Address
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Address Line | 81 EMMET AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-2228
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Country | US
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Telephone | 516-593-8408
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Fax | 516-887-9436
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 075009-1
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License Number State | NY
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