Provider Demographics
NPI:1992225411
Name:BERNARD, MARK A (LCSW-C, CAC-AD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BERNARD
Suffix:
Gender:M
Credentials:LCSW-C, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2829
Mailing Address - Country:US
Mailing Address - Phone:443-570-4837
Mailing Address - Fax:
Practice Address - Street 1:3100 LORD BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2879
Practice Address - Country:US
Practice Address - Phone:410-467-5291
Practice Address - Fax:443-708-8106
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2391101Y00000X
MD247591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor