Brucker, Sally S
Brucker, Sally S is an sole proprietor health care provider with primary practice located at 7700 Takoma Ave , Takoma Park MD 20912-4126. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Brucker, Sally S can be contacted via phone (301) 585-6904.Contact Information
Primary practice address
7700 Takoma Ave
Takoma Park MD 20912-4126
Phone: (301) 585-6904
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 07268 | Maryland |
Profile Details
| NPI number | 1780887703 |
|---|---|
| LBN Legal business name | Brucker, Sally S |
| Credentials | LCSW-C |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 7th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780887703 | NPPES |
| District of Columbia | Other | LC301961 | LICSW |
| District of Columbia | MEDICAID | 41003440 | LICSW |
| District of Columbia | Other | 07268 | LICSW |
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