Individual
DR. DORI ILENE BRENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
436 W MAIN ST, SECOND FLOOR, PATCHOGUE, NY 11772-3012
(631) 758-2170
Mailing address
40 W 4TH ST APT 158, PATCHOGUE, NY 11772-2134
(631) 758-3420
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
008877-1
NY
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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