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General NPI Number Information
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NPI Number | 1962403337
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Entity Type | Individual
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Provider Name | ROBIN CAROL BRUNGARD LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 489 MAIN ST SUITE 102
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-3187
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Country | US
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Telephone | 443-968-9266
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Fax | 410-414-5911
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Provider Business Mailing Address
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Address Line | PO BOX 1631 SUITE 102
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-1631
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Country | US
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Telephone | 443-968-9266
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Fax | 410-414-5911
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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 | 11218
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License Number State | MD
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