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Contact Information

BRUKE TADESSE
3415 HAMILTON ST STE 9
HYATTSVILLE, MD20782
 Phone: 301-779-2461
 Fax: 301-779-6095
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BRUKE TADESSE · (Male)

NPI Number 1306861752
Status Active
Credentials
Entity Individual
Enumeration date 07/13/2006
Last updated 04/13/2019 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • MD License # LC0295
  • MD Medicaid 1093750697
  • MD Medicaid 1316126121
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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