Provider Demographics
NPI:1255913539
Name:BRYK, BRADLEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:BRYK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 KENTLANDS BLVD # 13224
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5446
Mailing Address - Country:US
Mailing Address - Phone:917-225-8611
Mailing Address - Fax:
Practice Address - Street 1:106 OLD COURT RD STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4016
Practice Address - Country:US
Practice Address - Phone:917-225-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06584103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical