Individual provider Active NPI

Latrill Bryant-Bass, LMSW

  • Clinical Social Worker
  • Baltimore, MD
National Provider Identifier
1417804436
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LG200004601 Issued in DC
Practice address
4805 Garrison Blvd
Baltimore, MD 21215-5695
Phone
(443) 463-9523
Fax
(410) 510-1982
NPI assigned
Mar 11, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LG200004601 DC Primary

Addresses

Primary practice location

4805 Garrison Blvd
Baltimore, MD 21215-5695

Mailing address

202 Glenn Ellen Cir
Pikesville, MD 21208-1028
Phone (443) 463-9523

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LG200004601DCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Changing Lives at Home, Inc. Mental Health Current Accepting new patients
Changing Lives at Home Sud,Inc Current Accepting new patients
Changing Lives at Home Inc Mental Health Current Accepting new patients

Locations

4805 Garrison Blvd
Baltimore, MD 21215
Phone (410) 664-2400

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1417804436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 GLENN ELLEN CIR",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212081028",
            "telephone_number": "443-463-9523",
            "fax_number": "410-510-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 GARRISON BLVD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212155695",
            "telephone_number": "443-463-9523",
            "fax_number": "410-510-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYANT-BASS",
        "first_name": "LATRILL",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-03-11",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LG200004601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.