Provider Demographics
NPI:1225854607
Name:BRENNAN, CASEY ALEXANDRA
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:ALEXANDRA
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JENNINGS MILL PKWY APT 2102
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7462
Mailing Address - Country:US
Mailing Address - Phone:505-908-7452
Mailing Address - Fax:
Practice Address - Street 1:1360 CADUCEUS WAY BLDG 600
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7300
Practice Address - Country:US
Practice Address - Phone:762-499-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician