Provider Demographics
NPI:1730603895
Name:PRATT, BRIAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W CHURCH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7812
Mailing Address - Country:US
Mailing Address - Phone:240-415-8275
Mailing Address - Fax:
Practice Address - Street 1:120 W CHURCH ST STE 2E
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7812
Practice Address - Country:US
Practice Address - Phone:240-415-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14074275OtherCAQH