Provider Demographics
NPI:1578665170
Name:MAKOS, BERNARD D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:D
Last Name:MAKOS
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 1:3892 LAMBS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-9688
Mailing Address - Country:US
Mailing Address - Phone:570-662-7788
Mailing Address - Fax:570-662-7337
Practice Address - Street 1:3892 LAMBS CREEK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-9688
Practice Address - Country:US
Practice Address - Phone:570-662-7788
Practice Address - Fax:570-662-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005876-E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA799341Medicare ID - Type Unspecified