Healthcare Provider Details

I. General information

NPI: 1912234840
Provider Name (Legal Business Name): AMANDA NICHOLE BERNARDY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 27TH AVE S STE 4A
FARGO ND
58103-5449
US

IV. Provider business mailing address

2311 45TH ST S STE 4A
FARGO ND
58104-8408
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3301
  • Fax:
Mailing address:
  • Phone: 701-232-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4171
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: