Provider Demographics
NPI:1710444815
Name:LONEY, BRENDA B
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:B
Last Name:LONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 KELOX RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6280
Mailing Address - Country:US
Mailing Address - Phone:443-710-9952
Mailing Address - Fax:410-597-8180
Practice Address - Street 1:2801 GWYNNS FALLS PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2817
Practice Address - Country:US
Practice Address - Phone:410-396-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG063241041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty