Provider Demographics
NPI:1346772712
Name:BRIGHT HORIZONS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:BRIGHT HORIZONS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-288-3314
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0212
Mailing Address - Country:US
Mailing Address - Phone:571-288-3314
Mailing Address - Fax:888-760-4333
Practice Address - Street 1:1502 JOH AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1137
Practice Address - Country:US
Practice Address - Phone:571-288-3314
Practice Address - Fax:888-760-4333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHT HORIZONS BEHAVIORAL HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty