Provider Demographics
NPI:1073578670
Name:CHERNY, MARK JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:CHERNY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22131 SOLIEL CIR E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5344
Mailing Address - Country:US
Mailing Address - Phone:561-347-2458
Mailing Address - Fax:
Practice Address - Street 1:22131 SOLIEL CIR E
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5344
Practice Address - Country:US
Practice Address - Phone:561-347-2458
Practice Address - Fax:561-361-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW33731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5671OtherBLUECROSS BLUESHIELD FL
FL2019618OtherCIGNA
FLZ5671OtherBLUECROSS BLUESHIELD FL