Provider Demographics
NPI:1730115296
Name:IVIN, BERNARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:IVIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3033
Mailing Address - Country:US
Mailing Address - Phone:973-906-5265
Mailing Address - Fax:973-983-8229
Practice Address - Street 1:22 HOWARD BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1532
Practice Address - Country:US
Practice Address - Phone:973-906-5265
Practice Address - Fax:973-983-8229
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC472131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical