Provider Demographics
NPI:1548817570
Name:BRENNAN, NICOLLE SHEA
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:SHEA
Last Name:BRENNAN
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 1:2703 LOMAN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4287
Mailing Address - Country:US
Mailing Address - Phone:717-870-2698
Mailing Address - Fax:
Practice Address - Street 1:2703 LOMAN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4287
Practice Address - Country:US
Practice Address - Phone:717-870-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician