Provider Demographics
NPI:1568166767
Name:BRIGHT, MALOMO JULIAN
Entity Type:Individual
Prefix:
First Name:MALOMO
Middle Name:JULIAN
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 CHERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3652
Mailing Address - Country:US
Mailing Address - Phone:240-565-8862
Mailing Address - Fax:
Practice Address - Street 1:13609 AUTUMN END TER
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9473
Practice Address - Country:US
Practice Address - Phone:240-565-8862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician