Provider Demographics
NPI:1104158716
Name:BRYANT, SHEILA L (LCSW-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
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 1:604 SHIRLEY MANOR RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2319
Mailing Address - Country:US
Mailing Address - Phone:443-255-5408
Mailing Address - Fax:
Practice Address - Street 1:604 SHIRLEY MANOR RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2319
Practice Address - Country:US
Practice Address - Phone:443-255-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419159500Medicaid