Provider Demographics
NPI:1972648277
Name:BRETT, MARY-CLAIRE A (MS LCADC)
Entity Type:Individual
Prefix:
First Name:MARY-CLAIRE
Middle Name:A
Last Name:BRETT
Suffix:
Gender:F
Credentials:MS LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OAK LEAF CIR APT E
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2947
Mailing Address - Country:US
Mailing Address - Phone:410-515-1615
Mailing Address - Fax:410-879-2199
Practice Address - Street 1:5 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-8895
Practice Address - Country:US
Practice Address - Phone:410-879-6988
Practice Address - Fax:410-879-2199
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA003101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLCA003OtherMD DHMH PROFESSIONAL