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General NPI Number Information
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NPI Number | 1154110427
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Entity Type | Organization
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Legal Business Name | BRIGHTSPOT THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 9841 WASHINGTONIAN BLVD STE 200-1048
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5389
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Country | US
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Telephone | 571-308-6228
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Fax |
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Provider Business Mailing Address
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Address Line | 9841 WASHINGTONIAN BLVD STE 200-1048
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5389
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND PSYCHOTHERAPIST
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Name | JACQUELINE CASUMBAL
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Credential | LICSW, LCSW-C, LCSW
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Telephone | 571-308-6228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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