Provider Demographics
NPI:1619947538
Name:BERNZEN, BEVERLY BEHRMAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:BEHRMAN
Last Name:BERNZEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N DIXIE DR
Mailing Address - Street 2:#250
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5906
Mailing Address - Country:US
Mailing Address - Phone:979-285-3583
Mailing Address - Fax:979-299-1783
Practice Address - Street 1:115 N DIXIE DR
Practice Address - Street 2:#250
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5906
Practice Address - Country:US
Practice Address - Phone:979-285-3583
Practice Address - Fax:979-299-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063ESOtherBCBS
TX100767603Medicaid
TX100767603Medicaid