Provider Demographics
NPI:1700370681
Name:BRENNAN, KRISTIN MARIE (CPM, LM-RI)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CPM, LM-RI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1817
Mailing Address - Country:US
Mailing Address - Phone:413-777-8334
Mailing Address - Fax:413-294-9790
Practice Address - Street 1:1502 ALLEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1817
Practice Address - Country:US
Practice Address - Phone:413-777-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
RICPM00008176B00000X
MA17080012175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay