Provider Demographics
NPI:1588740963
Name:WERNICK, MARK JAY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:WERNICK
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:5039 STILLBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3150
Mailing Address - Country:US
Mailing Address - Phone:713-721-4944
Mailing Address - Fax:713-721-4944
Practice Address - Street 1:6750 WEST LOOP S
Practice Address - Street 2:225
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4103
Practice Address - Country:US
Practice Address - Phone:713-666-6116
Practice Address - Fax:713-721-4944
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX23491103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00836ZMedicare PIN