Provider Demographics
NPI:1528273489
Name:BRENNEN, PATRICK M (MSW, L C S W)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:BRENNEN
Suffix:
Gender:M
Credentials:MSW, L C S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 WILLOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3549
Mailing Address - Country:US
Mailing Address - Phone:304-598-2284
Mailing Address - Fax:
Practice Address - Street 1:253 WILLOWDALE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3549
Practice Address - Country:US
Practice Address - Phone:304-598-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCPE0812105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health