Healthcare Provider Details

I. General information

NPI: 1033744289
Provider Name (Legal Business Name): LORI BERNIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LORI BERNIER

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MANSFIELD AVE
WILLIMANTIC CT
06226-2045
US

IV. Provider business mailing address

112 MANSFIELD AVE
WILLIMANTIC CT
06226-2045
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-6793
  • Fax: 860-456-6957
Mailing address:
  • Phone: 860-456-6793
  • Fax: 860-456-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009313
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: