Provider Demographics
NPI:1093807067
Name:BRYANT, LAUREN R
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:R
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:R
Other - Last Name:MINTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD STE 408
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:443-913-0706
Mailing Address - Fax:410-771-9208
Practice Address - Street 1:11350 MCCORMICK RD STE 408
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:443-913-0706
Practice Address - Fax:410-771-9208
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0169631041C0700X
MD104101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
182964OtherCONPSYCH
MD431800500Medicaid
60875701OtherCAREFIRST MD
RS5830001OtherCAREFIRST GHMSI
MD431800500Medicaid