Provider Demographics
NPI:1407913189
Name:BERNSTEIN, SHARON L (LISW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 LA VETA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5133
Mailing Address - Country:US
Mailing Address - Phone:505-232-7664
Mailing Address - Fax:
Practice Address - Street 1:301 GRACELAND DR SE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2778
Practice Address - Country:US
Practice Address - Phone:505-269-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-046531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical