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General NPI Number Information
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NPI Number | 1346772712
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Entity Type | Organization
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Legal Business Name | BRIGHT HORIZONS BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1502 JOH AVE SUITE 180
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City | BALTIMORE
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State | MD
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Zip | 21227-1137
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Country | US
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Telephone | 571-288-3314
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Fax | 888-760-4333
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Provider Business Mailing Address
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Address Line | PO BOX 1212
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City | COLUMBIA
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State | MD
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Zip | 21044-0212
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Country | US
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Telephone | 571-288-3314
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Fax | 888-760-4333
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SANDRA MARTIN
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Credential |
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Telephone | 571-288-3314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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