Provider Demographics
NPI:1336414820
Name:HENNIGAN, BERNARD PAUL JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:PAUL
Last Name:HENNIGAN
Suffix:JR
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:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-0716
Mailing Address - Country:US
Mailing Address - Phone:443-520-0556
Mailing Address - Fax:
Practice Address - Street 1:25 W COURTLAND ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3749
Practice Address - Country:US
Practice Address - Phone:443-520-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional