Provider Demographics
NPI:1124462718
Name:DAUGHERTY, BRANDI (LCSW-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 CROSSROADS CIR
Mailing Address - Street 2:UNIT 450
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2946
Mailing Address - Country:US
Mailing Address - Phone:717-487-2573
Mailing Address - Fax:
Practice Address - Street 1:11550 CROSSROADS CIR
Practice Address - Street 2:UNIT 450
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-2946
Practice Address - Country:US
Practice Address - Phone:717-487-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical