Provider Demographics
NPI:1972217362
Name:SOTO, BRYAN ANTHONY (RBT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ANTHONY
Last Name:SOTO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WAUGH CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1246
Mailing Address - Country:US
Mailing Address - Phone:443-942-6220
Mailing Address - Fax:
Practice Address - Street 1:8950 OLD ANNAPOLIS RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2146
Practice Address - Country:US
Practice Address - Phone:443-863-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-22-247255106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician