Provider Demographics
NPI:1023838083
Name:PATINO, BREANNA (LGPC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:PATINO
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 RHODE ISLAND AVE APT 317
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1474
Mailing Address - Country:US
Mailing Address - Phone:908-884-3210
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR STE 730
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3523
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional