Provider Demographics
NPI:1851785471
Name:BERNARDIN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERNARDIN
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:PO BOX 10175
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0175
Mailing Address - Country:US
Mailing Address - Phone:360-519-7613
Mailing Address - Fax:
Practice Address - Street 1:945 HILDEBRAND LN NE
Practice Address - Street 2:SUITE 232
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2877
Practice Address - Country:US
Practice Address - Phone:360-519-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60537123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health