MEDICARE: SANDRA ELYSA BERNA LCMHC

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	101YM0800X	Mental Health Counselor	334	NH
2	101YM0800X	Mental Health Counselor	068-0000508	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790714939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA ELYSA BERNA LCMHC

Provider Business Mailing Address
First Line	:	1388 BLOCKHOUSE PT RD
Second Line	:
City	:	NORTH HERO
State	:	VT
Zip	:	05474-9666
Country	:	US
Telephone Number	:	802-527-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1388 BLOCKHOUSE PT RD
Second Line	:
City	:	NORTH HERO
State	:	VT
Zip	:	05474-9666
Country	:	US
Telephone Number	:	802-527-7494
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	06/24/2024

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