Provider Demographics
NPI:1124746698
Name:SANDRA BERNA LCMHC EMDR INTEGRATIVE SERVICES LLC
Entity type:Organization
Organization Name:SANDRA BERNA LCMHC EMDR INTEGRATIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:802-527-7494
Mailing Address - Street 1:1388 BLOCKHOUSE PT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05474-9666
Mailing Address - Country:US
Mailing Address - Phone:802-527-7494
Mailing Address - Fax:
Practice Address - Street 1:1388 BLOCKHOUSE PT RD
Practice Address - Street 2:
Practice Address - City:NORTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05474-9666
Practice Address - Country:US
Practice Address - Phone:802-527-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDRA BERNA LCMHC EMDR INTEGRATIVE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-19
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009871Medicaid