Provider Demographics
NPI:1932926052
Name:BERNIA, JACLYN MARGARET (MA, MBA)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARGARET
Last Name:BERNIA
Suffix:
Gender:F
Credentials:MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1580
Mailing Address - Country:US
Mailing Address - Phone:248-221-2766
Mailing Address - Fax:248-251-0270
Practice Address - Street 1:1500 N STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1580
Practice Address - Country:US
Practice Address - Phone:248-221-2766
Practice Address - Fax:248-251-0270
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical