Healthcare Provider Details

I. General information

NPI: 1760691091
Provider Name (Legal Business Name): CATHY SIMMONS BROOKMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E JOPPA RD SUITE 103
TOWSON MD
21286-3260
US

IV. Provider business mailing address

108 NEWBURG AVE
CATONSVILLE MD
21228-5109
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-3448
  • Fax:
Mailing address:
  • Phone: 410-747-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number02881
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: