Healthcare Provider Details

I. General information

NPI: 1518677046
Provider Name (Legal Business Name): BREYTA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

IV. Provider business mailing address

505 WINDY KNOLL DR UNIT 323
MOUNT AIRY MD
21771-6614
US

V. Phone/Fax

Practice location:
  • Phone: 240-668-4415
  • Fax: 240-673-6322
Mailing address:
  • Phone: 240-668-4415
  • Fax: 240-673-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CARLY ANSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 240-668-4415