Healthcare Provider Details

I. General information

NPI: 1215763636
Provider Name (Legal Business Name): BRANDY A DAVIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 10/30/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11921 ROCKVILLE PIKE SUITE 402
ROCKVILLE MD
20852
US

IV. Provider business mailing address

11921 ROCKVILLE PIKE SUITE 402
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 425-658-2254
  • Fax:
Mailing address:
  • Phone: 425-658-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: