Tisdale, Bruce Bernard

Tisdale, Bruce Bernard is an sole proprietor health care provider with primary practice located at 5211 Auth Road St 203 , Suitland MD 20746. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical, Ambulatory Health Care Facilities / Developmental Disabilities. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Tisdale, Bruce Bernard can be contacted via phone (202) 257-6632.

Contact Information

Primary practice address
5211 Auth Road St 203 Suitland MD 20746
Phone: (202) 257-6632
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LC50078990 District of Columbia
Behavioral Health & Social Service Providers / Social Worker 104100000X
Behavioral Health & Social Service Providers / Clinical 1041C0700X LC50078990 Maryland
Ambulatory Health Care Facilities / Developmental Disabilities 261QD1600X
Behavioral Health & Social Service Providers / Clinical 1041C0700X G11619 Maryland

Profile Details

NPI number 1588816490
LBN Legal business name Tisdale, Bruce Bernard
Credentials DSW, LICSW, LCSW-C
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 22nd, 2008
Last updated Jan 17th, 2024 - about 11 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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