Provider Demographics
NPI:1740845833
Name:ROSSMAN, BRADLEY DANIEL (LGPC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DANIEL
Last Name:ROSSMAN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 WHITE LAKE LN APT 301
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2924
Mailing Address - Country:US
Mailing Address - Phone:301-529-7573
Mailing Address - Fax:
Practice Address - Street 1:101 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4904
Practice Address - Country:US
Practice Address - Phone:240-513-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health