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General NPI Number Information
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NPI Number | 1033774989
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Entity Type | Organization
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Legal Business Name | BRANTWOOD FS LLC
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1190 AUGUSTINE HERMAN HWY
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City | ELKTON
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State | MD
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Zip | 21921-8251
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Country | US
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Telephone | 443-655-5116
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 AUGUSTINE HERMAN HWY
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City | ELKTON
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State | MD
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Zip | 21921-8251
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Country | US
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Telephone | 410-398-0651
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY GAMBLE
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Credential | LCSW-C
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Telephone | 410-398-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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