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General NPI Number Information
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NPI Number | 1538489588
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Entity Type | Individual
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Provider Name | VIRLETTA C. BRYANT PH.D., LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 2500 W NORTH AVE
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City | BALTIMORE
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State | MD
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Zip | 21216-3633
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Country | US
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Telephone | 301-404-2127
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 WOODELVES WAY
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City | CLINTON
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State | MD
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Zip | 20735-2451
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Country | US
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Telephone | 301-868-4640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15447
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50078297
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License Number State | DC
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