Active NPI
Eliot Michael Brenner, PH.D.
- Clinical Psychologist
- Fairfield, CT
National Provider Identifier
1972728129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 002434
- Practice address
- 1305 Post Rd
Suite 100
Fairfield, CT 06824-6016 - Phone
- (203) 209-9535
- NPI assigned
- Apr 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 002434 | CT | Primary |
Addresses
Primary practice location
1305 Post Rd
Suite 100
Fairfield, CT 06824-6016
Mailing address
171 Casmir Dr
Fairfield, CT 06825-1227
Phone (203) 373-0438
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002434 | CT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298851200000",
"number": "1972728129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 CASMIR DR",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068251227",
"telephone_number": "203-373-0438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 POST RD",
"address_2": "SUITE 100",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068246016",
"telephone_number": "203-209-9535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNER",
"first_name": "ELIOT",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-14",
"last_updated": "2011-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "002434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.