Provider Demographics
NPI:1881789774
Name:KOLENBRANDER, BRANDY TINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:TINA
Last Name:KOLENBRANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:TINA
Other - Last Name:MOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 RITCHIE HIGHWAY SUITE 1020
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:410-431-5111
Mailing Address - Fax:410-431-5112
Practice Address - Street 1:819 RITCHIE HIGHWAY SUITE 1020
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-431-5111
Practice Address - Fax:410-431-5112
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106681041C0700X
VA09040062871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033881800Medicaid