Provider Demographics
NPI:1164199857
Name:WIMBISH, BRANDY
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:WIMBISH
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 1:5000 FREDERICKS BEQUEST CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5622
Mailing Address - Country:US
Mailing Address - Phone:130-390-7943
Mailing Address - Fax:
Practice Address - Street 1:5000 FREDERICKS BEQUEST CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5622
Practice Address - Country:US
Practice Address - Phone:303-907-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical