Provider Demographics
NPI:1952865818
Name:MEYER, MARK EDWARD (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:MEYER
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 1:2900 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1716
Mailing Address - Country:US
Mailing Address - Phone:661-325-1742
Mailing Address - Fax:
Practice Address - Street 1:3512 COFFEE RD STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5078
Practice Address - Country:US
Practice Address - Phone:661-776-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW618451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW61845OtherLICENSED CLINICAL SOCIAL WORKER