Provider Demographics
NPI:1649587148
Name:BORCHARDT, BERNADETTE ELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ELENA
Last Name:BORCHARDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 WYANDOTTE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1509
Mailing Address - Country:US
Mailing Address - Phone:816-398-7858
Mailing Address - Fax:
Practice Address - Street 1:4635 WYANDOTTE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1509
Practice Address - Country:US
Practice Address - Phone:816-398-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130031181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649587148Medicaid