Provider Demographics
NPI:1750830683
Name:BRYANT, TANYA N (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:N
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 CLIFFEDGE RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4605
Mailing Address - Country:US
Mailing Address - Phone:410-977-8271
Mailing Address - Fax:410-455-5288
Practice Address - Street 1:4 W ROLLING
Practice Address - Street 2:SUITE 3
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6280
Practice Address - Country:US
Practice Address - Phone:410-455-5464
Practice Address - Fax:410-455-5288
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical