Provider Demographics
NPI:1225353121
Name:BRENNAN, LINDA (LCSW-R)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98120 QUEENS BLVD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4357
Mailing Address - Country:US
Mailing Address - Phone:718-830-0246
Mailing Address - Fax:
Practice Address - Street 1:3635 BELL BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2167
Practice Address - Country:US
Practice Address - Phone:718-830-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0780391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical