Provider Demographics
NPI:1861516445
Name:BERNSTEIN, MARCIA LYNN (MSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:NY
Mailing Address - Zip Code:12029-0280
Mailing Address - Country:US
Mailing Address - Phone:518-392-5136
Mailing Address - Fax:518-392-5136
Practice Address - Street 1:2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01266
Practice Address - Country:US
Practice Address - Phone:413-429-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical