Provider Demographics
NPI:1417732900
Name:BRAMHALL, JORDAN (MA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BRAMHALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 CHRISTMASBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7008
Mailing Address - Country:US
Mailing Address - Phone:240-439-0975
Mailing Address - Fax:
Practice Address - Street 1:14815 MANOR RD
Practice Address - Street 2:
Practice Address - City:MONKTON
Practice Address - State:MD
Practice Address - Zip Code:21111-2400
Practice Address - Country:US
Practice Address - Phone:410-205-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional