Provider Demographics
NPI:1104716695
Name:TAYLOR, BRIAN LANCE (LMSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LANCE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 COUNTRY VILLAGE DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4157
Mailing Address - Country:US
Mailing Address - Phone:717-698-7362
Mailing Address - Fax:
Practice Address - Street 1:1833 PULASKI HWY STE A
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1654
Practice Address - Country:US
Practice Address - Phone:443-484-2306
Practice Address - Fax:443-484-2970
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD32306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health