Provider Demographics
NPI:1336463686
Name:PENDLETON, BRIANNA LUNA (MS)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LUNA
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ARUNDEL AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4801
Mailing Address - Country:US
Mailing Address - Phone:443-995-0886
Mailing Address - Fax:
Practice Address - Street 1:175 ADMIRAL COCHRANE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7316
Practice Address - Country:US
Practice Address - Phone:410-571-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional