Provider Demographics
NPI:1710159793
Name:CORNISH, HERMAN AMBROSE (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:AMBROSE
Last Name:CORNISH
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 1:3865 TWIN LAKES CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3705
Mailing Address - Country:US
Mailing Address - Phone:410-922-1254
Mailing Address - Fax:410-922-1254
Practice Address - Street 1:1777 REISTERSTOWN RD
Practice Address - Street 2:SUITE 199
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1306
Practice Address - Country:US
Practice Address - Phone:410-764-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD044021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical