Provider Demographics
NPI:1396813994
Name:CHISHOLM, BERNICE I (MSW)
Entity Type:Individual
Prefix:MISS
First Name:BERNICE
Middle Name:I
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WEIRFIELD ST
Mailing Address - Street 2:APT. PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5123
Mailing Address - Country:US
Mailing Address - Phone:718-919-0210
Mailing Address - Fax:
Practice Address - Street 1:2021 GRAND CONCOURSE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4304
Practice Address - Country:US
Practice Address - Phone:718-960-0224
Practice Address - Fax:718-960-0241
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator