Provider Demographics
NPI:1255349858
Name:MAZE, BERNICE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:
Last Name:MAZE
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:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-0959
Mailing Address - Country:US
Mailing Address - Phone:256-582-8833
Mailing Address - Fax:256-582-8335
Practice Address - Street 1:1510 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1848
Practice Address - Country:US
Practice Address - Phone:256-582-8833
Practice Address - Fax:256-582-8335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AL1457C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51092776MAZOtherBCBS
AL051551554Medicaid
AL000092776Medicare PIN
ALS96494Medicare UPIN
AL51092776MAZOtherBCBS