MEDICARE: DANIEL J BERNAL MSW

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	LCSW-1769	AZ

General Provider Information

NPI Number	:	1497739684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J BERNAL MSW

Provider Business Mailing Address
First Line	:	1490 S PRICE RD
Second Line	:	SUITE 111-B
City	:	CHANDLER
State	:	AZ
Zip	:	85286-6607
Country	:	US
Telephone Number	:	480-545-2920
Fax Number	:	480-786-4266

Provider Business Practice Location Address
First Line	:	1490 S PRICE RD
Second Line	:	SUITE 111-B
City	:	CHANDLER
State	:	AZ
Zip	:	85286-6607
Country	:	US
Telephone Number	:	480-545-2920
Fax Number	:	480-786-4266

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	01/03/2011

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