MEDICARE: MR. BRUCE ANDREW FERGUSON L.C.P.C., N.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC2292	MD

General Provider Information

NPI Number	:	1619092988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE ANDREW FERGUSON L.C.P.C., N.C.C.

Provider Business Mailing Address
First Line	:	205 E FORT AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-4628
Country	:	US
Telephone Number	:	305-793-5583
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W BEL AIR AVE
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-3221
Country	:	US
Telephone Number	:	410-297-2271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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