Provider Demographics
NPI:1902930779
Name:SROKA-FRANCZKOWSKI, BERNADETTE
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:SROKA-FRANCZKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 STREAMSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2805
Mailing Address - Country:US
Mailing Address - Phone:410-879-9036
Mailing Address - Fax:
Practice Address - Street 1:3105 EMMORTON RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2582
Practice Address - Country:US
Practice Address - Phone:410-569-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional