Provider Demographics
NPI:1043438690
Name:BERNARD, FLORA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FLORA
Middle Name:L
Last Name:BERNARD
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 1:77 BAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1740
Mailing Address - Country:US
Mailing Address - Phone:201-759-4342
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE
Practice Address - Street 2:SUITE 101B
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3247
Practice Address - Country:US
Practice Address - Phone:201-759-4342
Practice Address - Fax:201-666-4651
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046163001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066764Medicare PIN