Provider Demographics
NPI:1902908585
Name:BRENNER, SARA W (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:W
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1211
Mailing Address - Country:US
Mailing Address - Phone:617-332-7908
Mailing Address - Fax:
Practice Address - Street 1:440 LEXINGTON ST
Practice Address - Street 2:SUITES 3-4
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1923
Practice Address - Country:US
Practice Address - Phone:617-332-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1042161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4304Medicare ID - Type UnspecifiedLICSW