Provider Demographics
NPI:1588949408
Name:BRENNAN, AILLINN (LPC)
Entity type:Individual
Prefix:
First Name:AILLINN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:139 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-1930
Mailing Address - Country:US
Mailing Address - Phone:917-865-9430
Mailing Address - Fax:
Practice Address - Street 1:139 W BROADWAY
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-1930
Practice Address - Country:US
Practice Address - Phone:917-865-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional