Healthcare Provider Details

I. General information

NPI: 1154284511
Provider Name (Legal Business Name): JILLIAN RAE BERNSTEIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAHOGANY DR
SILVER CITY NM
88061-8724
US

IV. Provider business mailing address

9 MAHOGANY DR
SILVER CITY NM
88061-8724
US

V. Phone/Fax

Practice location:
  • Phone: 575-284-9863
  • Fax:
Mailing address:
  • Phone: 575-284-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number418342
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0637
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: