MEDICARE: SANDRA BERNA LCMHC EMDR INTEGRATIVE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124746698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA BERNA LCMHC EMDR INTEGRATIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	1388 BLOCKHOUSE PT RD
Second Line	:
City	:	NORTH HERO
State	:	VT
Zip	:	05474-9666
Country	:	US
Telephone Number	:	802-527-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1388 BLOCKHOUSE PT RD
Second Line	:
City	:	NORTH HERO
State	:	VT
Zip	:	05474-9666
Country	:	US
Telephone Number	:	802-527-7494
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SANDRA E BERNA
Credential	:	LCMHC
Telephone Number	:	802-527-7494

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	06/24/2024

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