Healthcare Provider Details

I. General information

NPI: 1659469120
Provider Name (Legal Business Name): BERNADETTE E TRAYNOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRONX BLVD OUR LADY OF MERCY MENTAL HEALTH CLINIC
BRONX NY
10470
US

IV. Provider business mailing address

520 STANTON STATION RD
FLEMINGTON NJ
08822
US

V. Phone/Fax

Practice location:
  • Phone: 718-304-7012
  • Fax: 718-304-7065
Mailing address:
  • Phone: 908-237-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR0410731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: