Healthcare Provider Details

I. General information

NPI: 1376453985
Provider Name (Legal Business Name): MR. TIMOTHY SYDNEY BARTLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 RHODE ISLAND AVE
NORTH BRENTWOOD MD
20722-1224
US

IV. Provider business mailing address

4508 RHODE ISLAND AVE
NORTH BRENTWOOD MD
20722-1224
US

V. Phone/Fax

Practice location:
  • Phone: 240-667-6337
  • Fax:
Mailing address:
  • Phone: 240-667-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLG200004287
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: