Provider Demographics
NPI:1942428735
Name:LILLER, BRUCE ANDREW (LCPC)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ANDREW
Last Name:LILLER
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 1:700 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3302
Mailing Address - Country:US
Mailing Address - Phone:301-759-2852
Mailing Address - Fax:
Practice Address - Street 1:153 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2301
Practice Address - Country:US
Practice Address - Phone:301-759-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6902000000873BOtherBLUE CROSSBLUE SHIELD