Healthcare Provider Details

I. General information

NPI: 1205751682
Provider Name (Legal Business Name): BRODERICK PITTS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 LOCH RAVEN BLVD
BALTIMORE MD
21286-2302
US

IV. Provider business mailing address

2504 MADISON AVE
BALTIMORE MD
21217-4040
US

V. Phone/Fax

Practice location:
  • Phone: 410-497-5840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35286
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: