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General NPI Number Information
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NPI Number | 1902121940
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Entity Type | Organization
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Legal Business Name | BERNADETTE L. BRENNECKE, LCSW, INC.
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 4574 LIVE OAK CANYON ROAD
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City | LA VERNE
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State | CA
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Zip | 91750
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Country | US
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Telephone | 909-263-0851
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Fax | 626-338-9022
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Provider Business Mailing Address
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Address Line | 640 S. SUNSET AVE SUITE 102
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City | WEST COVINA
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State | CA
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Zip | 91790
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Country | US
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Telephone | 909-263-0851
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Fax | 626-338-9022
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. GREG PETROPOULOS
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Credential | LMFT
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Telephone | 909-263-0934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC 37681
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License Number State | CA
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