Provider Demographics
NPI:1982078804
Name:BERNIER, SHIRLEY
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:BERNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 RUTHVEN ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1730
Mailing Address - Country:US
Mailing Address - Phone:617-286-2772
Mailing Address - Fax:
Practice Address - Street 1:169 RUTHVEN ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1730
Practice Address - Country:US
Practice Address - Phone:617-286-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health