Healthcare Provider Details

I. General information

NPI: 1982142493
Provider Name (Legal Business Name): ELIZABETH KENNEY BRANDON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PARKWAY SUITE 209
COLUMBIA MD
21044
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PARKWAY SUITE 209
COLUMBIA MD
21044
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax: 410-740-8068
Mailing address:
  • Phone: 410-740-8066
  • Fax: 410-740-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG17765
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: