Healthcare Provider Details

I. General information

NPI: 1053403386
Provider Name (Legal Business Name): NEW HORIZONS PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10312 OLD FORT ROAD
FORT WASHINGTON MD
20744
US

IV. Provider business mailing address

10312 OLD FORT ROAD
FORT WASHINGTON MD
20744
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-3994
  • Fax: 304-725-3461
Mailing address:
  • Phone: 301-292-3994
  • Fax: 304-725-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number02802
License Number StateMD

VIII. Authorized Official

Name: DR. BONNIE LEE BRYANT
Title or Position: DIRECTOR
Credential: PHD
Phone: 571-594-9622