Individual
JERRY M BRENNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-277
HI
103TA0400X
Addiction (Substance Use Disorder) Psychologist
532-92
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000013417
BLUE CROSS
HI
01
—
00013417
HMSA
HI
01
—
01269301
ALOHACARE
HI
05
—
01269301
—
HI
01
—
067935000
MAGELLAN
HI
01
—
192826
SUMMERLIN
HI
01
—
99-0302920
TRI-CARE
HI
01
—
PSY-277
KAISER
HI
Enumeration date
09/13/2006
Last updated
07/29/2011
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