Provider Demographics
NPI:1215583521
Name:SUSAN BERNSTEIN, LCSW, LICSW, LLC
Entity Type:Organization
Organization Name:SUSAN BERNSTEIN, LCSW, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, LICSW
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-308-3145
Mailing Address - Street 1:836 FARMINGTON AVE STE 221B
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-308-3145
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 221B
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
Practice Address - Country:US
Practice Address - Phone:860-308-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty