Provider Demographics
NPI:1619385150
Name:BERN, DEBORAH (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:BERN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4204
Mailing Address - Country:US
Mailing Address - Phone:917-744-2343
Mailing Address - Fax:
Practice Address - Street 1:193 FOREST AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-4204
Practice Address - Country:US
Practice Address - Phone:917-744-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR011277-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker