Provider Demographics
NPI:1013292762
Name:BEDNAR, TRACY ANN (LGPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 PUBLIC LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-2453
Mailing Address - Country:US
Mailing Address - Phone:410-632-1100
Mailing Address - Fax:410-632-5682
Practice Address - Street 1:9730 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1154
Practice Address - Country:US
Practice Address - Phone:410-629-0164
Practice Address - Fax:410-629-0185
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health