Provider Demographics
NPI:1043944234
Name:BRENNAN, LORI ANN (LMSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 VINCELLETTE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2251
Mailing Address - Country:US
Mailing Address - Phone:203-864-5166
Mailing Address - Fax:
Practice Address - Street 1:50 FITCH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1366
Practice Address - Country:US
Practice Address - Phone:203-361-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMSW.005024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker