Provider Demographics
NPI:1972759991
Name:GRAY, BRANDY KUEREINE (MED, BCBA, LB)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:KUEREINE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MED, BCBA, LB
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:KUEREINE
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LB
Mailing Address - Street 1:6801 OAK HALL LN UNIT 7053
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-7611
Mailing Address - Country:US
Mailing Address - Phone:301-801-1376
Mailing Address - Fax:
Practice Address - Street 1:5895 MORNINGBIRD LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3520
Practice Address - Country:US
Practice Address - Phone:301-802-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-07-3491101YM0800X
MDLBA001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health