Provider Demographics
NPI:1427273218
Name:BERNAL, AIDA SORAYA (LCSW)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:SORAYA
Last Name:BERNAL
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 1:5203 BENTPINE COVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0892
Mailing Address - Country:US
Mailing Address - Phone:904-562-1391
Mailing Address - Fax:904-562-1361
Practice Address - Street 1:5203 BENTPINE COVE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0892
Practice Address - Country:US
Practice Address - Phone:904-562-1391
Practice Address - Fax:904-562-1361
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069324-11041C0700X
VA09040061201041C0700X
FLSW 137971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical