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General NPI Number Information
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NPI Number | 1689172470
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Entity Type | Individual
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Provider Name | BROOKE FARAN CORNETT MSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 239 MAIN ST
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1213
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Country | US
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Telephone | 443-253-5676
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Fax |
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Provider Business Mailing Address
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Address Line | 2102 EMORY RD
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City | REISTERSTOWN
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State | MD
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Zip | 21136-4020
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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 |
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Name |
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Credential |
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Telephone |
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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 | 20919
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License Number State | MD
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