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NPI Code Detail

MEDICARE: MR. BERNARD IVIN L.C.S.W.

MEDICARE: MR. BERNARD IVIN L.C.S.W.
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
11041C0700XClinical Social WorkerSC47213NJ

General Provider Information

NPI Number : 1730115296
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BERNARD IVIN L.C.S.W.
Provider Business Mailing Address
First Line : 8 SANDPIPER DR
Second Line :
City : HACKETTSTOWN
State : NJ
Zip : 07840-3033
Country : US
Telephone Number : 973-906-5265
Fax Number : 973-983-8229
Provider Business Practice Location Address
First Line : 22 HOWARD BLVD
Second Line : SUITE 101
City : MOUNT ARLINGTON
State : NJ
Zip : 07856-1532
Country : US
Telephone Number : 973-906-5265
Fax Number : 973-983-8229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 07/08/2007

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