Provider Demographics
NPI:1558577825
Name:BERNSTEIN, KENNETH H (LICSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:H
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HEDGEROW LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1695
Mailing Address - Country:US
Mailing Address - Phone:413-256-3100
Mailing Address - Fax:
Practice Address - Street 1:5 HEDGEROW LN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1695
Practice Address - Country:US
Practice Address - Phone:413-256-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1078431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07475OtherBLUE CROSS BLUE SHIELD