Provider Demographics
NPI:1194091207
Name:DESVARIEUX, BERNANIE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BERNANIE
Middle Name:MARIE
Last Name:DESVARIEUX
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 1:1587 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2115
Mailing Address - Country:US
Mailing Address - Phone:516-632-8395
Mailing Address - Fax:516-632-8395
Practice Address - Street 1:1587 DECATUR ST
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2115
Practice Address - Country:US
Practice Address - Phone:516-632-8395
Practice Address - Fax:516-632-8395
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool