Provider Demographics
NPI:1225856743
Name:BRADDY, BIANCA M (ADT)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:M
Last Name:BRADDY
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 OLYMPIC SQ UNIT 132
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3973
Mailing Address - Country:US
Mailing Address - Phone:410-877-5489
Mailing Address - Fax:
Practice Address - Street 1:1101 N POINT BLVD STE 128
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3417
Practice Address - Country:US
Practice Address - Phone:443-231-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT2230101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)