Provider Demographics
NPI:1730289901
Name:SLUTSKY, BERNARD ALAN (MA LICSW)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:ALAN
Last Name:SLUTSKY
Suffix:
Gender:M
Credentials:MA LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 FORESTVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5501
Mailing Address - Country:US
Mailing Address - Phone:763-541-8176
Mailing Address - Fax:763-201-1095
Practice Address - Street 1:7225 FORESTVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5501
Practice Address - Country:US
Practice Address - Phone:763-541-8176
Practice Address - Fax:763-201-1095
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN029321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical