=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346878626
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORENER BRAYBOY LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2020
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8901 ROCKVILLE PIKE
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20889-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-967-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8901 ROCKVILLE PIKE
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20889-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-967-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC50079178
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------