Provider Demographics
NPI:1235799859
Name:BRODT, ALEX (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BRODT
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:LEWIS
Other - Last Name:BRODT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:10538 E WIND WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5606
Mailing Address - Country:US
Mailing Address - Phone:240-401-7288
Mailing Address - Fax:
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY STE 245
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6240
Practice Address - Country:US
Practice Address - Phone:443-823-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD203251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical