Provider Demographics
NPI:1962619213
Name:BRENN, ADRIAN CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:CHARLES
Last Name:BRENN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5700
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-5556
Mailing Address - Country:US
Mailing Address - Phone:670-322-1925
Mailing Address - Fax:670-322-1926
Practice Address - Street 1:5700 CHRB
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-5556
Practice Address - Country:US
Practice Address - Phone:670-322-1925
Practice Address - Fax:670-322-1926
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP5103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist