Provider Demographics
NPI:1609556935
Name:BERNARD, ANGEL MICHELLE (LSW, CDCA)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MICHELLE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W APPLE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2617
Mailing Address - Country:US
Mailing Address - Phone:937-986-9629
Mailing Address - Fax:
Practice Address - Street 1:120 W APPLE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2617
Practice Address - Country:US
Practice Address - Phone:937-222-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.22074421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical