Healthcare Provider Details

I. General information

NPI: 1245001239
Provider Name (Legal Business Name): KERIANNE BROWN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SULGRAVE AVE STE 304
BALTIMORE MD
21209-3651
US

IV. Provider business mailing address

1501 SULGRAVE AVE STE 304
BALTIMORE MD
21209-3651
US

V. Phone/Fax

Practice location:
  • Phone: 410-216-4514
  • Fax:
Mailing address:
  • Phone: 410-216-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30209
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: