Organization
ELISE BERSHAW, LCSW-C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELISE WENDY BERSHAW LCSW-C (PSYCHOTHERAPIST)
(410) 212-9463
Entity
Organization
Contact information
Practice address
10 W MADISON ST, LOWER LEVEL, BALTIMORE, MD 21201-5239
(410) 212-9463
Mailing address
PO BOX 67149, BALTIMORE, MD 21215
(410) 212-9463
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
12123
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932331139
SOLO NPI
MD
Enumeration date
01/12/2017
Last updated
01/12/2017
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