Provider Demographics
NPI:1265883888
Name:BERNARD, LAUREN GILBERT (LCPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:GILBERT
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 DALMATION PL APT 301
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-2619
Mailing Address - Country:US
Mailing Address - Phone:410-417-7464
Mailing Address - Fax:
Practice Address - Street 1:305 W CHESAPEAKE AVE STE 501
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-9936
Practice Address - Country:US
Practice Address - Phone:410-417-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional