Basic Information
| Provider Information | |||||||||
| NPI: | 1831587096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNSTEIN | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10593 TWIN RIVERS RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437429867 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5560 STERRETT PL STE 201 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435464000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2014 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC5369 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.