Individual
JONATHAN BRANDONISIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LGPC
Contact information
Practice address
6999 REISTERSTOWN RD, BALTIMORE, MD 21215-1430
(443) 345-9674
Mailing address
6999 REISTERSTOWN RD, BALTIMORE, MD 21215-1430
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP8180
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306665
—
MD
Enumeration date
11/14/2018
Last updated
11/14/2018
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