Provider Demographics
NPI:1770786758
Name:DVORAK, MICHAEL A (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:DVORAK
Suffix:
Gender:M
Credentials:LCSW-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9199 REISTERSTOWN ROAD
Mailing Address - Street 2:SUITE 105-B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-356-8260
Mailing Address - Fax:410-356-8299
Practice Address - Street 1:9199 REISTERSTOWN ROAD
Practice Address - Street 2:SUITE 105-B
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-356-8260
Practice Address - Fax:410-356-8299
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD089081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD565L419WMedicare PIN