Provider Demographics
NPI:1487810669
Name:BERNARD, SHIRLEY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:BERNARD
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 1:175 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1102
Mailing Address - Country:US
Mailing Address - Phone:718-436-7600
Mailing Address - Fax:718-436-8101
Practice Address - Street 1:203 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4398
Practice Address - Country:US
Practice Address - Phone:919-670-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1745501041C0700X
NY097962-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical