Provider Demographics
NPI:1124489133
Name:BERNARD, DOMINIQUE R (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:R
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2950 NORTH LOOP W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8843
Mailing Address - Country:US
Mailing Address - Phone:866-262-4581
Mailing Address - Fax:
Practice Address - Street 1:2950 NORTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8843
Practice Address - Country:US
Practice Address - Phone:866-262-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595611041C0700X, 104100000X
LA109821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical