Provider Demographics
NPI:1952493603
Name:BERNSDORFF, JUTTA ELISABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:ELISABETH
Last Name:BERNSDORFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CRANE CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8204
Mailing Address - Country:US
Mailing Address - Phone:727-733-3816
Mailing Address - Fax:
Practice Address - Street 1:1020 CRANE CT
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8204
Practice Address - Country:US
Practice Address - Phone:727-733-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 00023161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 0002316OtherLICENSED CLINICAL SOCIAL