Provider Demographics
NPI:1073677969
Name:BRESLER, JACK I (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:I
Last Name:BRESLER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12267 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3328
Mailing Address - Country:US
Mailing Address - Phone:240-314-7086
Mailing Address - Fax:
Practice Address - Street 1:12267 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3328
Practice Address - Country:US
Practice Address - Phone:240-314-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health