Provider Demographics
NPI:1568186476
Name:BRAMHALL, MARY KATHERINE (LGPC)
Entity Type:Individual
Prefix:
First Name:MARY KATHERINE
Middle Name:
Last Name:BRAMHALL
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7843
Mailing Address - Country:US
Mailing Address - Phone:717-514-1271
Mailing Address - Fax:
Practice Address - Street 1:20 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7843
Practice Address - Country:US
Practice Address - Phone:717-514-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty