Provider Demographics
NPI:1578116158
Name:GREYHART, BROOKE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:GREYHART
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 E PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5673
Mailing Address - Country:US
Mailing Address - Phone:240-397-9722
Mailing Address - Fax:
Practice Address - Street 1:53 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5673
Practice Address - Country:US
Practice Address - Phone:240-397-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60915310103TC0700X
MA11240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical