Provider Demographics
NPI:1831667500
Name:BRODY, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BRODY
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 1:9734 MORNINGVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9024
Mailing Address - Country:US
Mailing Address - Phone:443-461-4585
Mailing Address - Fax:
Practice Address - Street 1:336 S MAIN ST STE 2C
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3978
Practice Address - Country:US
Practice Address - Phone:443-461-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-10
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical