Provider Demographics
NPI:1871683862
Name:BERNSTEIN, JILL (MED LMHC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HIGH STREET
Mailing Address - Street 2:SUITE A8
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3819
Mailing Address - Country:US
Mailing Address - Phone:781-391-6222
Mailing Address - Fax:781-391-6119
Practice Address - Street 1:84 HIGH STREET
Practice Address - Street 2:SUITE A8
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3819
Practice Address - Country:US
Practice Address - Phone:781-391-6222
Practice Address - Fax:781-391-6119
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA606101YM0800X
MA200207104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
723061OtherTUFTS
6217025OtherUNITED HEALTHCARE
LM0172OtherBCBS
318040OtherMBC
12A215641000OtherMBC