Provider Demographics
NPI:1154945947
Name:BRODE, JANET LYNNE (LCPC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LYNNE
Last Name:BRODE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LYNNE
Other - Last Name:BRODE-TENEYCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:7712 ERICA LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3626
Mailing Address - Country:US
Mailing Address - Phone:240-353-3123
Mailing Address - Fax:
Practice Address - Street 1:7712 ERICA LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3626
Practice Address - Country:US
Practice Address - Phone:240-353-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health