Provider Demographics
NPI:1962497008
Name:MAKOSKY, BERNADETTE A (LISW)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:A
Last Name:MAKOSKY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N GLENN DR NE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9759
Mailing Address - Country:US
Mailing Address - Phone:740-407-3213
Mailing Address - Fax:
Practice Address - Street 1:337 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3845
Practice Address - Country:US
Practice Address - Phone:740-407-3213
Practice Address - Fax:740-785-5189
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1008401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA272168000OtherAETNA
IA272168000OtherMAGELLAN
IA36075OtherBLUE CROSS/BLUE SHIELD
IA272168000OtherAETNA