Provider Demographics
NPI:1275716359
Name:BERNARD, MARA REGINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:REGINA
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 1:12811 KENWOOD LN STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5667
Mailing Address - Country:US
Mailing Address - Phone:239-537-9646
Mailing Address - Fax:239-236-0066
Practice Address - Street 1:12811 KENWOOD LN STE 602
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5667
Practice Address - Country:US
Practice Address - Phone:239-537-9646
Practice Address - Fax:239-236-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW184491041C0700X
NYR049610-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical