Provider Demographics
NPI:1902430044
Name:BERNARD, JENNIFER NOEL (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOEL
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 COOK STREET
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1500
Mailing Address - Country:US
Mailing Address - Phone:978-407-5697
Mailing Address - Fax:
Practice Address - Street 1:126 COOK STREET
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1500
Practice Address - Country:US
Practice Address - Phone:978-407-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health