Provider Demographics
NPI:1114380748
Name:DELORME, BERNICE (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:DELORME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BERNICE
Other - Middle Name:
Other - Last Name:DELORME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 152
Practice Address - Street 2:JOHN NORQUAY STREET
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker