Provider Demographics
NPI:1346580875
Name:BERNARD, SARAH E (MA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793-1 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9744
Mailing Address - Country:US
Mailing Address - Phone:219-203-2343
Mailing Address - Fax:
Practice Address - Street 1:793-1 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-9744
Practice Address - Country:US
Practice Address - Phone:219-203-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000481A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87000481AOtherINDIANA PROFESSIONAL LICENSING AGENCY