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NPI Code Detail

MEDICARE: STEPHEN BRENNAN

MEDICARE: STEPHEN BRENNAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health CounselorCC02552MN

General Provider Information

NPI Number : 1053873406
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN BRENNAN
Provider Business Mailing Address
First Line : 2000 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-3713
Country : US
Telephone Number : 612-235-4620
Fax Number : 651-437-1808
Provider Business Practice Location Address
First Line : 2000 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-3713
Country : US
Telephone Number : 612-235-4620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 07/30/2024

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Directions to “ STEPHEN BRENNAN ” Practice Location

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