Provider Demographics
NPI:1588084966
Name:BRENNAN, KARISSA (LMHC)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 LENOX AVE
Mailing Address - Street 2:11P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1247
Mailing Address - Country:US
Mailing Address - Phone:908-963-6044
Mailing Address - Fax:
Practice Address - Street 1:630 LENOX AVE
Practice Address - Street 2:11P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1247
Practice Address - Country:US
Practice Address - Phone:908-963-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health