Provider Demographics
NPI:1770249435
Name:BRYANT, CHERYL LYNN (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
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 1:4715 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1402
Mailing Address - Country:US
Mailing Address - Phone:443-791-7148
Mailing Address - Fax:
Practice Address - Street 1:4715 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1402
Practice Address - Country:US
Practice Address - Phone:443-791-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD781302300Medicaid