Provider Demographics
NPI:1487218178
Name:BERNAZAR, BRENDA (MS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BERNAZAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-2127
Mailing Address - Country:US
Mailing Address - Phone:413-209-6775
Mailing Address - Fax:
Practice Address - Street 1:30 OLD LYMAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2630
Practice Address - Country:US
Practice Address - Phone:413-533-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01020OtherTUFTS