Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Bruce Bernard Tisdale, DSW, LICSW, LCSW-C

Individual provider Mental Health Counselor · NPI 1588816490

Mr. Bruce Bernard Tisdale, DSW, LICSW, LCSW-C is a Clinical Social Worker in Suitland, Maryland. Qualified in 2004, 22 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in District of Columbia and Maryland.

Years since qualifying
22
Licensed in
DC, MD
In the registry since
2008
Specialties on file
5
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

See every abbreviation used in this directory →

Practice location Address checks out

5211 Auth Road St 203
Suitland, MD 20746
Phone: (202) 257-6632
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence G11619 (MD)
Mental Health Counselor Taxonomy 101YM0800X · Licence LC50078990 (DC)
Social Worker Taxonomy 104100000X
Clinical Social Worker Taxonomy 1041C0700X · Licence LC50078990 (MD)
Developmental Disabilities Clinic/Center Taxonomy 261QD1600X

Record details

NPI number1588816490
Entity typeIndividual (Type 1)
GenderMale
Credentials DSW , LICSW , LCSW-C
Sole proprietorYes
NPI enumeratedOctober 22, 2008
Last updated in NPPESJanuary 17, 2024
Certification dateJanuary 17, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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