Provider Demographics
NPI:1720186752
Name:DIBERNARD, NANCY CAROL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CAROL
Last Name:DIBERNARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:CAROL
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:285 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:908-707-0212
Mailing Address - Fax:908-707-8498
Practice Address - Street 1:285 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-707-0212
Practice Address - Fax:908-707-8498
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00296600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional