Provider Demographics
NPI:1265697361
Name:BRENNAN-KOLISCZ, EVANGELINE
Entity type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:
Last Name:BRENNAN-KOLISCZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-3144
Mailing Address - Country:US
Mailing Address - Phone:401-435-8008
Mailing Address - Fax:
Practice Address - Street 1:1563 N MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2983
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:508-679-8590
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency