Provider Demographics
NPI:1295301661
Name:GRANT, BARRY ALLEN
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:ALLEN
Last Name:GRANT
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 1:6201 GREENBELT RD STE L4
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2357
Mailing Address - Country:US
Mailing Address - Phone:240-965-7262
Mailing Address - Fax:240-553-7262
Practice Address - Street 1:6201 GREENBELT RD STE L4
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2357
Practice Address - Country:US
Practice Address - Phone:240-965-7262
Practice Address - Fax:240-553-7262
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)