Provider Demographics
NPI:1568689891
Name:DENDE, JOHN (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DENDE
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 1:10402 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3926
Mailing Address - Country:US
Mailing Address - Phone:301-910-4357
Mailing Address - Fax:301-530-4020
Practice Address - Street 1:909 DRUID PARK LAKE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4531
Practice Address - Country:US
Practice Address - Phone:301-910-4357
Practice Address - Fax:301-530-4020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001290401Medicaid
MD001290400Medicaid