Basic Information
| Provider Information | |||||||||
| NPI: | 1609426683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNAL | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | LINDA | ||||||||
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| Credential: | LCSW, LCADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 ROUTE 17 NORTH | ||||||||
| Address2: | |||||||||
| City: | MAYWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519964450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 87 ROUTE 17 NORTH | ||||||||
| Address2: | |||||||||
| City: | MAYWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519962000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2019 | ||||||||
| LastUpdateDate: | 12/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 37LC00331100 | NJ | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 44SC05900200 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.