Provider Demographics
NPI:1063580439
Name:BRENNER, LAURENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:BRENNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 ROOSEVELT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1434
Mailing Address - Country:US
Mailing Address - Phone:415-861-4788
Mailing Address - Fax:
Practice Address - Street 1:1348 10TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2304
Practice Address - Country:US
Practice Address - Phone:415-564-2310
Practice Address - Fax:415-564-2313
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent