Provider Demographics
NPI:1801046057
Name:FAWCETT, BRENDA E (PH D)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:PH D
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Other - Last Name:
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Mailing Address - Street 1:2931 E BIDDLE ST
Mailing Address - Street 2:PATIENT ACCOUNTING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-3939
Mailing Address - Country:US
Mailing Address - Phone:443-923-1886
Mailing Address - Fax:443-923-1895
Practice Address - Street 1:707 N BROADWAY
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1832
Practice Address - Country:US
Practice Address - Phone:443-923-9200
Practice Address - Fax:443-923-9405
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD2940103TC2200X
DC1673103TC2200X
VA2033103TC2200X
MA3182103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent