Provider Demographics
NPI:1639449168
Name:BARD, JODY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:
Last Name:BARD
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 1:10A HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2406
Mailing Address - Country:US
Mailing Address - Phone:845-639-6660
Mailing Address - Fax:
Practice Address - Street 1:3 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1324
Practice Address - Country:US
Practice Address - Phone:845-469-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042487101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool