MEDICARE: LAURA M BERNABE LMHC,CASAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12927	NY
2	101YM0800X	Mental Health Counselor	000535	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12927	OTHER	NY	CREDENTIAL NUMBER
2	000535	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1396881371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M BERNABE LMHC,CASAC

Provider Business Mailing Address
First Line	:	2345 ROUTE 52
Second Line	:	SUITE F
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3218
Country	:	US
Telephone Number	:	845-206-6512
Fax Number	:	888-972-5017

Provider Business Practice Location Address
First Line	:	2345 ROUTE 52
Second Line	:	SUITE F
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3218
Country	:	US
Telephone Number	:	845-206-6512
Fax Number	:	888-972-5017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/22/2016

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