Healthcare Provider Details

I. General information

NPI: 1902032253
Provider Name (Legal Business Name): JEFF BERNARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 1ST ST
NAPA CA
94559-2841
US

IV. Provider business mailing address

1546 1ST ST
NAPA CA
94559-2841
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-4560
  • Fax: 707-253-8118
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: