Provider Demographics
NPI:1740993823
Name:BERNARD, MADISON (CSW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 HARRODS POINTE TRCE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1407
Mailing Address - Country:US
Mailing Address - Phone:859-608-2366
Mailing Address - Fax:
Practice Address - Street 1:448 LEWIS HARGETT CIR STE 260
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3506
Practice Address - Country:US
Practice Address - Phone:859-338-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2575621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical