Healthcare Provider Details

I. General information

NPI: 1720852056
Provider Name (Legal Business Name): KATANNA DION-BERNIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 LAKE AVE N
WORCESTER MA
01605-2072
US

IV. Provider business mailing address

9 BARON PARK LN APT 36
BURLINGTON MA
01803-5458
US

V. Phone/Fax

Practice location:
  • Phone: 508-749-5585
  • Fax:
Mailing address:
  • Phone: 207-205-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: