Provider Demographics
NPI:1841843208
Name:BRACEY, SHANNON (PSYCHOLOGY ASSOCIATE)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:BRACEY
Suffix:
Gender:F
Credentials:PSYCHOLOGY ASSOCIATE
Other - Prefix:DR
Other - First Name:DIAMOND
Other - Middle Name:
Other - Last Name:BRACEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4244
Mailing Address - Country:US
Mailing Address - Phone:240-686-5390
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4244
Practice Address - Country:US
Practice Address - Phone:240-686-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01217103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling