Healthcare Provider Details

I. General information

NPI: 1245843812
Provider Name (Legal Business Name): ALEXIS MORGAN BROOM MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 APPEAL LANE
LUSBY MD
20657-2935
US

IV. Provider business mailing address

20 APPEAL LN
LUSBY MD
20657-2935
US

V. Phone/Fax

Practice location:
  • Phone: 410-394-0681
  • Fax:
Mailing address:
  • Phone: 410-394-0681
  • Fax: 410-326-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: