Healthcare Provider Details

I. General information

NPI: 1285334003
Provider Name (Legal Business Name): BRIGHT LIFE THERAPY , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 THOMAS JOHNSON DR STE 203
FREDERICK MD
21702-5122
US

IV. Provider business mailing address

188 THOMAS JOHNSON DR STE 203
FREDERICK MD
21702-5122
US

V. Phone/Fax

Practice location:
  • Phone: 240-658-8825
  • Fax:
Mailing address:
  • Phone: 240-658-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANI CERRITOS
Title or Position: THERAPIST
Credential: LCSW-C
Phone: 240-658-8825