Provider Demographics
NPI:1265759104
Name:STIPELMAN, BROOKE A (PHD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:A
Last Name:STIPELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 HUNTSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2308
Mailing Address - Country:US
Mailing Address - Phone:732-208-3042
Mailing Address - Fax:
Practice Address - Street 1:3841 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2004
Practice Address - Country:US
Practice Address - Phone:301-949-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical