Provider Demographics
NPI:1124792056
Name:BRANDENBURG, BRANDY LYNN (LCSW-C)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:BRANDENBURG
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 1:5305 JEFFERSON PIKE STE C7
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6982
Mailing Address - Country:US
Mailing Address - Phone:240-656-0201
Mailing Address - Fax:
Practice Address - Street 1:5305 JEFFERSON PIKE STE C7
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6982
Practice Address - Country:US
Practice Address - Phone:240-656-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD266031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB653-098-564-744OtherNONE