MEDICARE: KATHERINE BERNAL LCSW

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	1041C0700X	Clinical Social Worker	14992	FL

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	:	1174038012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE BERNAL LCSW

Provider Business Mailing Address
First Line	:	2890 56TH AVENUE CIR E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-5371
Country	:	US
Telephone Number	:	941-296-5068
Fax Number	:	941-340-0625

Provider Business Practice Location Address
First Line	:	2100 CONSTITUTION BLVD STE 118
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-4146
Country	:	US
Telephone Number	:	941-567-7085
Fax Number	:

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

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	01/26/2026

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