Provider Demographics
NPI:1396280152
Name:ASHA BERNARD
Entity type:Organization
Organization Name:ASHA BERNARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, GRS
Authorized Official - Phone:201-787-9205
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:BROOKSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07926-0420
Mailing Address - Country:US
Mailing Address - Phone:201-787-9205
Mailing Address - Fax:
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1865
Practice Address - Country:US
Practice Address - Phone:973-370-0278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00408300101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty