Provider Demographics
NPI:1780910455
Name:BERNIER, BERTHLYN M (MSW)
Entity type:Individual
Prefix:
First Name:BERTHLYN
Middle Name:M
Last Name:BERNIER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BERTHLYN
Other - Middle Name:M
Other - Last Name:BERNIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW/LICSW
Mailing Address - Street 1:121 RUSKIN RD.
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136
Mailing Address - Country:US
Mailing Address - Phone:781-588-2216
Mailing Address - Fax:
Practice Address - Street 1:184 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2561
Practice Address - Country:US
Practice Address - Phone:617-442-2002
Practice Address - Fax:617-442-4002
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1113601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical