Healthcare Provider Details

I. General information

NPI: 1780509885
Provider Name (Legal Business Name): NOMI VAN DEN BROECK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W PATRICK ST STE 2-B
FREDERICK MD
21701-4889
US

IV. Provider business mailing address

3200 RIVERWALK PL UNIT 332
FREDERICK MD
21701-3658
US

V. Phone/Fax

Practice location:
  • Phone: 240-732-0414
  • Fax:
Mailing address:
  • Phone: 630-770-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34771
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: