Healthcare Provider Details

I. General information

NPI: 1902154438
Provider Name (Legal Business Name): KEVIN MICHAEL BERNEY PMHNP, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 DEAN ST STE 13
TAUNTON MA
02780-2766
US

IV. Provider business mailing address

912 PARK PL
RAYNHAM MA
02767-8069
US

V. Phone/Fax

Practice location:
  • Phone: 508-824-2273
  • Fax:
Mailing address:
  • Phone: 774-319-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2348275
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118997
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: