Healthcare Provider Details

I. General information

NPI: 1407161821
Provider Name (Legal Business Name): LYNDA MARIE BERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 BROADWAY LOWER LEVEL
NEWBURGH NY
12550-5408
US

IV. Provider business mailing address

633 GIDNEY AVE STE 6
NEWBURGH NY
12550-2805
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-8255
  • Fax: 845-562-4140
Mailing address:
  • Phone: 845-569-2900
  • Fax: 866-619-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082816-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: