Provider Demographics
NPI:1457387268
Name:BERNDT, IRENE J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:J
Last Name:BERNDT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S 4TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4715
Mailing Address - Country:US
Mailing Address - Phone:701-795-3000
Mailing Address - Fax:107-795-3050
Practice Address - Street 1:151 S 4TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-795-3000
Practice Address - Fax:107-795-3050
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN73B00BEOtherBCBS MN PROVIDER NUMBER
ND7936408OtherAETNA PIN NUMBER
ND054519Medicaid
ND020540OtherBCBS ND PROVIDER NUMBER
ND020540OtherBCBS ND PROVIDER NUMBER