Provider Demographics
NPI:1609964725
Name:BARDY, MIREILLE ANNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MIREILLE
Middle Name:ANNE
Last Name:BARDY
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 1:7600 BOONE AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4563
Mailing Address - Country:US
Mailing Address - Phone:763-515-2456
Mailing Address - Fax:763-515-2442
Practice Address - Street 1:7600 BOONE AVE N
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-4563
Practice Address - Country:US
Practice Address - Phone:763-515-2456
Practice Address - Fax:763-515-2442
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN149321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical