Provider Demographics
NPI:1659884948
Name:ADAMSON, BERNELL
Entity Type:Individual
Prefix:
First Name:BERNELL
Middle Name:
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 SE WEST DUNBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8122
Mailing Address - Country:US
Mailing Address - Phone:850-295-9409
Mailing Address - Fax:
Practice Address - Street 1:345 E WEATHERBEE RD LOT 23
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8540
Practice Address - Country:US
Practice Address - Phone:850-358-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician