Individual
COLETTE A BRUNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
5550 STERRETT PLCE, SUITE 314, COLUMBIA, MD 21044
(410) 730-6119
(410) 290-6550
Mailing address
6119 MINUTE HAND COURT, COLUMBIA, MD 21044
(410) 730-3896
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
05994
MD
1041C0700X
Clinical Social Worker
Primary
05994
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30171
MAMSI ID
MD
01
—
36140003
CAREFIRST DC PLAN
MD
01
—
42560901
CAREFIRST MD PLAN
MD
01
—
521885475
FED TAX ID
MD
Enumeration date
10/02/2006
Last updated
07/20/2015
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