Provider Demographics
NPI:1851964191
Name:RESH, BRAEDYN
Entity Type:Individual
Prefix:
First Name:BRAEDYN
Middle Name:
Last Name:RESH
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 1:1812 BALTIMORE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7144
Mailing Address - Country:US
Mailing Address - Phone:443-590-0030
Mailing Address - Fax:888-316-2327
Practice Address - Street 1:1812 BALTIMORE BLVD STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7144
Practice Address - Country:US
Practice Address - Phone:443-590-0030
Practice Address - Fax:888-316-2327
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP11654OtherLICENSE