Provider Demographics
NPI:1093759912
Name:GOOD, MARK CAMERON (LCSW-C, BCD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CAMERON
Last Name:GOOD
Suffix:
Gender:M
Credentials:LCSW-C, BCD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 OLD SOLOMONS ISLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-266-9747
Mailing Address - Fax:410-266-9749
Practice Address - Street 1:133 OLD SOLOMONS ISLAND ROAD
Practice Address - Street 2:BAYSHORE COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-9747
Practice Address - Fax:410-266-9749
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06493104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD199381000Medicaid
MD52220901OtherBCBS OF MARYLAND
QS17Medicare PIN