Provider Demographics
NPI:1992782510
Name:BRENNER, LUIS ANTONIO (LCSW, LAC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ANTONIO
Last Name:BRENNER
Suffix:
Gender:M
Credentials:LCSW, LAC
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 7051
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-6421
Mailing Address - Country:US
Mailing Address - Phone:317-791-1171
Mailing Address - Fax:317-791-1303
Practice Address - Street 1:7210 MADISON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5267
Practice Address - Country:US
Practice Address - Phone:317-791-1171
Practice Address - Fax:317-791-1303
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003325A1041C0700X
IN84000078A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171100000XOther Service ProvidersAcupuncturist