Provider Demographics
NPI:1104108737
Name:BERNARDEZ, ROSE MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:BERNARDEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 HIGHWAY 109
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1160
Mailing Address - Country:US
Mailing Address - Phone:314-802-2599
Mailing Address - Fax:636-273-9813
Practice Address - Street 1:2634 HIGHWAY 109
Practice Address - Street 2:SUITE E
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1160
Practice Address - Country:US
Practice Address - Phone:314-802-2599
Practice Address - Fax:636-273-9813
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060190531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical