Provider Demographics
NPI:1346721115
Name:BERNARDI, MIA SERABIAN (MHC)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:SERABIAN
Last Name:BERNARDI
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:GILBERT
Other - Last Name:SERABIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC
Mailing Address - Street 1:138 W 25TH ST FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7405
Mailing Address - Country:US
Mailing Address - Phone:646-786-1793
Mailing Address - Fax:
Practice Address - Street 1:138 W 25TH ST FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:646-786-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP12893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health