Provider Demographics
NPI:1851887616
Name:KIJESKY, BRENDA H (LCMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:H
Last Name:KIJESKY
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK EP 3 RD STE LL4
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8916
Mailing Address - Country:US
Mailing Address - Phone:410-927-5462
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK EP 3 RD STE LL4
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-8916
Practice Address - Country:US
Practice Address - Phone:410-927-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist