MEDICARE: KRISTIN BRENNER LMSW

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	057188-01	NY

General Provider Information

NPI Number	:	1316694839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BRENNER LMSW

Provider Business Mailing Address
First Line	:	210 CHURCH ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1010
Country	:	US
Telephone Number	:	518-580-0520
Fax Number	:	518-580-9975

Provider Business Practice Location Address
First Line	:	683 ROUTE 29
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-5403
Country	:	US
Telephone Number	:	518-580-0520
Fax Number	:	518-580-9975

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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