Provider Demographics
NPI:1669161881
Name:BERNARD, PAULINE (PHD, LMSW)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COURT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6922
Mailing Address - Country:US
Mailing Address - Phone:203-848-0790
Mailing Address - Fax:
Practice Address - Street 1:329 E 62ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7769
Practice Address - Country:US
Practice Address - Phone:203-848-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117698-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker