1447735972 NPI number — MEREDITH H BRADEN-MACMULLAN LCPC, NCC

Table of content: MEREDITH H BRADEN-MACMULLAN LCPC, NCC (NPI 1447735972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447735972 NPI number — MEREDITH H BRADEN-MACMULLAN LCPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADEN-MACMULLAN
Provider First Name:
MEREDITH
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADEN
Provider Other First Name:
MEREDITH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447735972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 CATHEDRAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-507-5474
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 BESTGATE RD STE 325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-4291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-906-3506
Provider Business Practice Location Address Fax Number:
443-782-2342
Provider Enumeration Date:
10/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC10837 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 367255700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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