Provider Demographics
NPI:1114682911
Name:CHERRY, BREANNA NIAMBI
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:NIAMBI
Last Name:CHERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 REGENCY PL STE 203
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3088
Mailing Address - Country:US
Mailing Address - Phone:240-427-3554
Mailing Address - Fax:
Practice Address - Street 1:5010 REGENCY PL STE 203
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3088
Practice Address - Country:US
Practice Address - Phone:240-427-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health