Provider Demographics
NPI:1417543638
Name:BERNARD, MIKAELA NICOLE (MSW TLSW)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:NICOLE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MSW TLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23789 GARRETT HWY
Mailing Address - Street 2:
Mailing Address - City:MC HENRY
Mailing Address - State:MD
Mailing Address - Zip Code:21541-1338
Mailing Address - Country:US
Mailing Address - Phone:304-435-8892
Mailing Address - Fax:
Practice Address - Street 1:23789 GARRETT HWY
Practice Address - Street 2:
Practice Address - City:MC HENRY
Practice Address - State:MD
Practice Address - Zip Code:21541-1338
Practice Address - Country:US
Practice Address - Phone:304-435-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD263301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical