Healthcare Provider Details

I. General information

NPI: 1568583979
Provider Name (Legal Business Name): LYNNE BERNAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 MILITARY TRAIL FAMILY COUNSELING ASSOCIATES INC
JUPITER FL
33458
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-2775
  • Fax: 561-747-1881
Mailing address:
  • Phone: 561-747-2775
  • Fax: 561-616-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW4936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: