MEDICARE: BRAMBLE BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1568211050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAMBLE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	77 LITTLE NEW YORK RD
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-1935
Country	:	US
Telephone Number	:	443-945-5346
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 LITTLE NEW YORK RD
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-1935
Country	:	US
Telephone Number	:	443-945-5346
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA L BRAMBLE
Credential	:	LCSWC
Telephone Number	:	443-945-5346

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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