Provider Demographics
NPI:1780626564
Name:BERNER, GWENDOLYN A (LCSW)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:A
Last Name:BERNER
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 1:1218 TERRACE MILL DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4168
Mailing Address - Country:US
Mailing Address - Phone:972-533-7770
Mailing Address - Fax:972-881-9728
Practice Address - Street 1:1218 TERRACE MILL DR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4168
Practice Address - Country:US
Practice Address - Phone:972-533-7770
Practice Address - Fax:972-881-9728
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS399751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
274383OtherMHN
4411595OtherAETNA
TX0046LJOtherBLUECROSS BLUESHIELD
058543OtherVALUEOPTIONS
254584000OtherMAGELLAN HEALTH SERVICES
1175126OtherCIGNA BEHAVIORAL HEALTH
254584000OtherMAGELLAN HEALTH SERVICES
TX611260Medicare PIN