MEDICARE: MELINDA 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356984959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA BRENNAN

Provider Business Mailing Address
First Line	:	52 WILSON RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-5157
Country	:	US
Telephone Number	:	845-662-5302
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 WILSON RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-5157
Country	:	US
Telephone Number	:	845-662-5302
Fax Number	:

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

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	10/26/2019

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Directions to “ MELINDA BRENNAN ” Practice Location

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