Provider Demographics
NPI:1467890350
Name:LARDNER, MARK DENIS (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DENIS
Last Name:LARDNER
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 W LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4215
Mailing Address - Country:US
Mailing Address - Phone:443-615-3670
Mailing Address - Fax:
Practice Address - Street 1:234 W LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4215
Practice Address - Country:US
Practice Address - Phone:443-615-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health