Provider Demographics
NPI:1750830170
Name:BACKERT, JOHN (LCPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BACKERT
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 1:9201 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4318
Mailing Address - Country:US
Mailing Address - Phone:410-574-7700
Mailing Address - Fax:
Practice Address - Street 1:9201 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-574-7700
Practice Address - Fax:410-574-1522
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC8756OtherLCPC