Provider Demographics
NPI:1053389387
Name:THARP BRENNAN, MARY JANE (LPC, CAC, CEAP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:THARP BRENNAN
Suffix:
Gender:F
Credentials:LPC, CAC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2608
Mailing Address - Country:US
Mailing Address - Phone:814-459-5088
Mailing Address - Fax:814-453-7545
Practice Address - Street 1:3610 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2608
Practice Address - Country:US
Practice Address - Phone:814-459-5088
Practice Address - Fax:814-453-7545
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002482101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC002482OtherLICENSED PROFESSIONAL COU