Provider Demographics
NPI:1699459701
Name:BERNARD, JOANNE (LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39550 DUN ROVIN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3475
Mailing Address - Country:US
Mailing Address - Phone:904-624-0775
Mailing Address - Fax:
Practice Address - Street 1:39550 DUN ROVIN DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3475
Practice Address - Country:US
Practice Address - Phone:904-624-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100301041C0700X
MI68010168891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical