Provider Demographics
NPI:1295007250
Name:BERNSTEIN, DAPHNA (LCSW)
Entity Type:Individual
Prefix:
First Name:DAPHNA
Middle Name:
Last Name:BERNSTEIN
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 1:6 SOLDIERS FIELD PARK
Mailing Address - Street 2:APT# 319
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02163-1728
Mailing Address - Country:US
Mailing Address - Phone:857-756-5641
Mailing Address - Fax:
Practice Address - Street 1:6 SOLDIERS FIELD PARK
Practice Address - Street 2:APT# 319
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02163-1728
Practice Address - Country:US
Practice Address - Phone:857-756-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2169211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA058907763OtherSOCIAL SERVICES