Provider Demographics
NPI:1447735972
Name:BRADEN-MACMULLAN, MEREDITH H (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:H
Last Name:BRADEN-MACMULLAN
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, NCC
Mailing Address - Street 1:104 CATHEDRAL ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2704
Mailing Address - Country:US
Mailing Address - Phone:410-507-5474
Mailing Address - Fax:
Practice Address - Street 1:810 BESTGATE RD STE 325
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4291
Practice Address - Country:US
Practice Address - Phone:443-906-3506
Practice Address - Fax:443-782-2342
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10837101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD367255700Medicaid