Provider Demographics
NPI:1851516124
Name:BERNSTEIN, JUDITH (MSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4280
Mailing Address - Country:US
Mailing Address - Phone:707-303-3235
Mailing Address - Fax:707-526-8319
Practice Address - Street 1:659 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4280
Practice Address - Country:US
Practice Address - Phone:707-303-3235
Practice Address - Fax:707-526-8319
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS103291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical