Provider Demographics
NPI:1770754830
Name:BERNARD, JAIME ELIZABETH (LCDP)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:ELIZABETH
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:55 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3617
Mailing Address - Country:US
Mailing Address - Phone:401-789-1367
Mailing Address - Fax:401-789-1367
Practice Address - Street 1:4705 OLD POST RD UNIT A
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1842
Practice Address - Country:US
Practice Address - Phone:401-789-1367
Practice Address - Fax:401-364-3310
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00412101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)