Healthcare Provider Details

I. General information

NPI: 1578966883
Provider Name (Legal Business Name): THE BRAMBLE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N FREDERICK AVE SUITE 300
GAITHERSBURG MD
20877-2507
US

IV. Provider business mailing address

501 N FREDERICK AVE SUITE 300
GAITHERSBURG MD
20877-2507
US

V. Phone/Fax

Practice location:
  • Phone: 301-651-4594
  • Fax: 301-830-4594
Mailing address:
  • Phone: 301-651-4594
  • Fax: 301-830-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC1990
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA388
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC1990
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1990
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number14931
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number14931
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number14931
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14931
License Number StateMD
# 9
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14931
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14931
License Number StateMD

VIII. Authorized Official

Name: MS. SIMONE BRAMBLE
Title or Position: CEO
Credential: LCSW-C
Phone: 301-651-4594