Provider Demographics
NPI:1528281417
Name:GUIDRY, BERNADETTE (MS)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 W 11TH ST
Mailing Address - Street 2:SUITE 337
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3821
Mailing Address - Country:US
Mailing Address - Phone:209-627-8345
Mailing Address - Fax:
Practice Address - Street 1:82 CATAMOUNT PARK
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1292
Practice Address - Country:US
Practice Address - Phone:802-388-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50705106H00000X
101Y00000X
VT100-0133998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health