Healthcare Provider Details

I. General information

NPI: 1619803145
Provider Name (Legal Business Name): MICHAEL BRENNAN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 HICKORY RIDGE RD
COLUMBIA MD
21044-3626
US

IV. Provider business mailing address

14721 COBBLESTONE DR
SILVER SPRING MD
20905-5812
US

V. Phone/Fax

Practice location:
  • Phone: 410-387-2763
  • Fax:
Mailing address:
  • Phone: 410-387-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34762
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: