Provider Demographics
NPI:1003143702
Name:AMATO, BERNADETTE PURCELL (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:PURCELL
Last Name:AMATO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AVON BY THE SEA
Mailing Address - State:NJ
Mailing Address - Zip Code:07717-1147
Mailing Address - Country:US
Mailing Address - Phone:732-859-9639
Mailing Address - Fax:
Practice Address - Street 1:416 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:AVON BY THE SEA
Practice Address - State:NJ
Practice Address - Zip Code:07717-1147
Practice Address - Country:US
Practice Address - Phone:732-859-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054055001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical