Provider Demographics
NPI:1942747019
Name:BERNARDEZ, NATALIE ANNE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:BERNARDEZ
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 1:2107 13TH STREET CT NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1349
Mailing Address - Country:US
Mailing Address - Phone:954-604-4087
Mailing Address - Fax:
Practice Address - Street 1:11110 SW 25TH CT
Practice Address - Street 2:APT 12203
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7667
Practice Address - Country:US
Practice Address - Phone:954-604-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-42244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst