Healthcare Provider Details

I. General information

NPI: 1518688100
Provider Name (Legal Business Name): BCB LIBERTY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CHARLES ST STE 901
BALTIMORE MD
21201-3740
US

IV. Provider business mailing address

7410 RIGBY PL
ELKRIDGE MD
21075-7287
US

V. Phone/Fax

Practice location:
  • Phone: 937-422-4039
  • Fax: 410-888-3889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE BONU
Title or Position: PRESIDENT
Credential:
Phone: 374-224-0939