Provider Demographics
NPI:1952422685
Name:BERNARD, DENISE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:BERNARD
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 1:201 N WINSTEAD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2307
Mailing Address - Country:US
Mailing Address - Phone:252-937-8222
Mailing Address - Fax:
Practice Address - Street 1:201 N WINSTEAD AVE STE A
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2307
Practice Address - Country:US
Practice Address - Phone:252-923-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007042Medicaid
NCQ38101AOtherMEDICARE