Provider Demographics
NPI:1871051698
Name:BRENNER, LESA (LMSW)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:423 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4225
Mailing Address - Country:US
Mailing Address - Phone:517-420-0394
Mailing Address - Fax:
Practice Address - Street 1:3317 GREENLEAF BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2516
Practice Address - Country:US
Practice Address - Phone:269-216-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801106485104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical