Provider Demographics
NPI:1598824633
Name:BRONFMAN, SHELLY (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:
Last Name:BRONFMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 BRANDYWINE ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4530
Mailing Address - Country:US
Mailing Address - Phone:202-363-4033
Mailing Address - Fax:
Practice Address - Street 1:751 TWINBROOK PKWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1400
Practice Address - Country:US
Practice Address - Phone:240-777-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD031731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical