Provider Demographics
NPI:1932477080
Name:BERNARD, DESIREE DAWN (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:DAWN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LMSW-CC
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 505
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224
Mailing Address - Country:US
Mailing Address - Phone:207-329-5409
Mailing Address - Fax:
Practice Address - Street 1:155 CENTER ST # F
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5229
Practice Address - Country:US
Practice Address - Phone:207-329-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELM13312104100000X
MEMC134551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker