MEDICARE: ELIZABETH BERNARD

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	101Y00000X	Counselor	806	PR

General Provider Information

NPI Number	:	1164438511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BERNARD

Provider Business Mailing Address
First Line	:	HC 1 BOX 20205
Second Line	:
City	:	COMERIO
State	:	PR
Zip	:	00782-9718
Country	:	US
Telephone Number	:	787-875-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	DURABO CLUSTER AB 101
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	787-316-5590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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