MEDICARE: MRS. SUSAN LYNN BRENNER MSW

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
1	1041C0700X	Clinical Social Worker	I1000141	OH
2	101Y00000X	Counselor	I1000141	OH

General Provider Information

NPI Number	:	1235441866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN LYNN BRENNER MSW

Provider Business Mailing Address
First Line	:	6579 KARINCREST DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45044-9548
Country	:	US
Telephone Number	:	513-207-3386
Fax Number	:	513-777-0982

Provider Business Practice Location Address
First Line	:	6942 TYLERSVILLE RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1511
Country	:	US
Telephone Number	:	513-868-0055
Fax Number	:	513-297-7577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	08/21/2012

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