Provider Demographics
NPI:1063568582
Name:DUGUAY, BERNADETTE DANIELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:DANIELLE
Last Name:DUGUAY
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 1:8614 W DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3536
Mailing Address - Country:US
Mailing Address - Phone:602-832-1378
Mailing Address - Fax:
Practice Address - Street 1:2000 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1910
Practice Address - Country:US
Practice Address - Phone:602-257-3814
Practice Address - Fax:602-257-3924
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-102161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ713653OtherACHHS