Provider Demographics
NPI:1134110620
Name:BROWN-BUSHROD, DIONNE MICHELLE (LCSW C MSW)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:MICHELLE
Last Name:BROWN-BUSHROD
Suffix:
Gender:F
Credentials:LCSW C MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9902 REISTERSTOWN RD
Mailing Address - Street 2:# 360
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3945
Mailing Address - Country:US
Mailing Address - Phone:410-484-6070
Mailing Address - Fax:410-484-3166
Practice Address - Street 1:3713 TALL GRASS CT
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2824
Practice Address - Country:US
Practice Address - Phone:410-484-6070
Practice Address - Fax:410-992-8522
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD091331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD348600100Medicaid