Provider Demographics
NPI:1245843812
Name:BROOM, ALEXIS MORGAN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MORGAN
Last Name:BROOM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 APPEAL LN
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2935
Mailing Address - Country:US
Mailing Address - Phone:410-394-0681
Mailing Address - Fax:410-326-1860
Practice Address - Street 1:20 APPEAL LANE
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2935
Practice Address - Country:US
Practice Address - Phone:410-394-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD285511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program