Healthcare Provider Details

I. General information

NPI: 1922709146
Provider Name (Legal Business Name): BRIGHT HORIZONS PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7360 GUILFORD DR STE 100
FREDERICK MD
21704-5128
US

IV. Provider business mailing address

6000 EXECUTIVE BLVD STE 101
NORTH BETHESDA MD
20852-3816
US

V. Phone/Fax

Practice location:
  • Phone: 240-599-1001
  • Fax: 240-599-1002
Mailing address:
  • Phone: 240-599-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIR ETESAM
Title or Position: OWNER
Credential: MD
Phone: 240-599-1001