Healthcare Provider Details

I. General information

NPI: 1386658581
Provider Name (Legal Business Name): JEFFREY MAURICE BERNIER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 FOOTE ST
CORINTH MS
38834-4834
US

IV. Provider business mailing address

601 FOOTE ST
CORINTH MS
38834-4834
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-4424
  • Fax:
Mailing address:
  • Phone: 662-287-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01687
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: