Provider Demographics
NPI:1588616320
Name:BERNARD, JANET E (LICSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 WESTFORD ST # U2-A
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5225
Mailing Address - Country:US
Mailing Address - Phone:978-244-1264
Mailing Address - Fax:
Practice Address - Street 1:73 PRINCETON ST STE 310
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1559
Practice Address - Country:US
Practice Address - Phone:978-244-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104919104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03050OtherBLUE CROSS
MAP21067Medicare ID - Type Unspecified