Basic Information
| Provider Information | |||||||||
| NPI: | 1821032467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENNAN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1052 29TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973213416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418125060 | ||||||||
| FaxNumber: | 5419267234 | ||||||||
| Practice Location | |||||||||
| Address1: | 1052 29TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973213416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418125060 | ||||||||
| FaxNumber: | 5419267234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1341 | OR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.