MEDICARE: MRS. ARLENE SANDRA BRENNER CCC-SLP

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	235Z00000X	Speech-Language Pathologist	00-1268-1	NY

General Provider Information

NPI Number	:	1669754982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARLENE SANDRA BRENNER CCC-SLP

Provider Business Mailing Address
First Line	:	365 S MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3061
Country	:	US
Telephone Number	:	845-634-2900
Fax Number	:	845-634-3066

Provider Business Practice Location Address
First Line	:	441 N LITTLE TOR RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-2332
Country	:	US
Telephone Number	:	845-638-1548
Fax Number	:

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

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/13/2011

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