Provider Demographics
NPI:1043652464
Name:BRYANT, CELENA A (PSY D)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8756 WHITTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7008
Mailing Address - Country:US
Mailing Address - Phone:571-213-6100
Mailing Address - Fax:571-213-6100
Practice Address - Street 1:8756 WHITTINGTON ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-7008
Practice Address - Country:US
Practice Address - Phone:571-213-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical