MEDICARE: MS. ROBIN CHURCHILL BERNHARD LCSW M ED

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	0904004843	VA

General Provider Information

NPI Number	:	1275753618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBIN CHURCHILL BERNHARD LCSW M ED

Provider Business Mailing Address
First Line	:	420 THIRD STREET NE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-4620
Country	:	US
Telephone Number	:	434-878-3146
Fax Number	:	800-605-1939

Provider Business Practice Location Address
First Line	:	420 THIRD STREET NE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-1751
Country	:	US
Telephone Number	:	434-878-3146
Fax Number	:	800-605-1939

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	11/27/2018

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