Healthcare Provider Details

I. General information

NPI: 1083716211
Provider Name (Legal Business Name): ROBERTA BERNITT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD APT 1C
REGO PARK NY
11374-4357
US

IV. Provider business mailing address

98120 QUEENS BLVD APT 1C
REGO PARK NY
11374-4357
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax: 718-830-9088
Mailing address:
  • Phone: 718-830-0246
  • Fax: 718-830-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number047904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: