Provider Demographics
NPI:1306978648
Name:JONES, BERNADETTE MARIE
Entity type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:627 NANSEMOND ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1111
Mailing Address - Country:US
Mailing Address - Phone:757-399-4267
Mailing Address - Fax:
Practice Address - Street 1:6224 PORTSMOUTH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1345
Practice Address - Country:US
Practice Address - Phone:757-686-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040004821041C0700X
NMI-26641041C0700X
CO9911391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical