Provider Demographics
NPI:1770287070
Name:SOP, BRENDALINE
Entity type:Individual
Prefix:
First Name:BRENDALINE
Middle Name:
Last Name:SOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 ROXY DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2064
Mailing Address - Country:US
Mailing Address - Phone:240-394-1814
Mailing Address - Fax:
Practice Address - Street 1:7525 ROXY DR
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2064
Practice Address - Country:US
Practice Address - Phone:240-394-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator