Healthcare Provider Details

I. General information

NPI: 1609601848
Provider Name (Legal Business Name): BROOKE RICHMAN MA LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 DULANEY VALLEY RD STE 3
TOWSON MD
21204-5132
US

IV. Provider business mailing address

803 GRUNDY ST
BALTIMORE MD
21224-4346
US

V. Phone/Fax

Practice location:
  • Phone: 301-852-3993
  • Fax:
Mailing address:
  • Phone: 301-852-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC18364
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: