Provider Demographics
NPI:1871007781
Name:BERNARD, JASMINE KEANA (LCSW, LSSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:KEANA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LCSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 KAYSER MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5977
Mailing Address - Country:US
Mailing Address - Phone:850-240-6170
Mailing Address - Fax:
Practice Address - Street 1:7008 KAYSER MILL RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5977
Practice Address - Country:US
Practice Address - Phone:850-240-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-10036104100000X
NMC-109741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker