Organization
BCB LIBERTY HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINE BONU (PRESIDENT)
(374) 224-0939
Entity
Organization
Contact information
Practice address
1638 R ST NW, WASHINGTON, DC 20009-6446
(937) 422-4093
Mailing address
7410 RIGBY PL, ELKRIDGE, MD 21075-7287
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
09/12/2022
Last updated
04/19/2023
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