Provider Demographics
NPI:1306598891
Name:ENCARNACAO, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ENCARNACAO
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 1:1400 W LOMBARD ST # 1001
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-3134
Mailing Address - Country:US
Mailing Address - Phone:443-695-2838
Mailing Address - Fax:
Practice Address - Street 1:1400 W LOMBARD ST # 1001
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-3134
Practice Address - Country:US
Practice Address - Phone:443-628-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2023-08-14
Deactivation Date:2023-07-25
Deactivation Code:
Reactivation Date:2023-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist