Provider Demographics
NPI:1073096889
Name:BERNICK, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BERNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1-14 BUNKYO-MACHI
Mailing Address - Street 2:NAGASAKI UNIVERSITY STUDENT ACCESSIBILITY OFFICE
Mailing Address - City:NAGASAKI
Mailing Address - State:NAGASAKI
Mailing Address - Zip Code:8528521
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1-14 BUNKYO-MACHI
Practice Address - Street 2:NAGASAKI UNIVERSITY STUDENT ACCESSIBILITY OFFICE
Practice Address - City:NAGASAKI
Practice Address - State:NAGASAKI
Practice Address - Zip Code:8528521
Practice Address - Country:JP
Practice Address - Phone:095-819-2006
Practice Address - Fax:095-819-2974
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1190961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical