Provider Demographics
NPI:1720294564
Name:BERNAT, ALISA LYNNE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LYNNE
Last Name:BERNAT
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MENDON ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1438
Mailing Address - Country:US
Mailing Address - Phone:508-340-1352
Mailing Address - Fax:
Practice Address - Street 1:228 MENDON ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1438
Practice Address - Country:US
Practice Address - Phone:508-340-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health