Mark Wilkerson, PH.D

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

LBA710 Issued in MD

Practice address

4655 Pinto CT
Ellicott City, MD 21043-6416

Phone

(215) 520-6774

NPI assigned

Oct 31, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Dr. Mark Wilkerson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1083258107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 PINTO CT",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 PINTO CT",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436416",
            "telephone_number": "215-520-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-31",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "MD",
            "license": "LBA710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "WILKERSON",
            "prefix": "DR.",
            "credential": "MARK WILKERSON, PH.D",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lori Kristen Whitworth, OTR
• Kelly Joy Whorton, LCSW-C
• Robert J Wicks, PSY.D
• Dina Wieczynski
• Melissa Wiedel
• Tyeisha Wilkins Witherspoon, AGPCNP
• Florica Willard, LCMFT
• Adolphus Williams
• Cicely Williams
• Jannel Jessi Williams

• Behavior Analyst in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Behavior Analyst in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.