Provider Demographics
NPI:1497739684
Name:BERNAL, DANIEL J (MSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:BERNAL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 S PRICE RD
Mailing Address - Street 2:SUITE 111-B
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6607
Mailing Address - Country:US
Mailing Address - Phone:480-545-2920
Mailing Address - Fax:480-786-4266
Practice Address - Street 1:1490 S PRICE RD
Practice Address - Street 2:SUITE 111-B
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6607
Practice Address - Country:US
Practice Address - Phone:480-545-2920
Practice Address - Fax:480-786-4266
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-17691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical