Provider Demographics
NPI:1154110427
Name:BRIGHTSPOT THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:BRIGHTSPOT THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASUMBAL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C, LCSW
Authorized Official - Phone:571-308-6228
Mailing Address - Street 1:9841 WASHINGTONIAN BLVD STE 200-1048
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9841 WASHINGTONIAN BLVD STE 200-1048
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5389
Practice Address - Country:US
Practice Address - Phone:571-308-6228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty