Provider Demographics
NPI:1154284511
Name:BERNSTEIN, JILLIAN RAE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:RAE
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAHOGANY DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-8724
Mailing Address - Country:US
Mailing Address - Phone:575-284-9863
Mailing Address - Fax:
Practice Address - Street 1:9 MAHOGANY DR
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-8724
Practice Address - Country:US
Practice Address - Phone:575-284-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4183421041S0200X
NMSWB-2025-0637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty