Provider Demographics
NPI:1679790364
Name:BERNARD, SYNDIA
Entity type:Individual
Prefix:MS
First Name:SYNDIA
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4404
Mailing Address - Country:US
Mailing Address - Phone:718-488-0100
Mailing Address - Fax:718-488-0129
Practice Address - Street 1:199 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1907
Practice Address - Country:US
Practice Address - Phone:718-488-0100
Practice Address - Fax:718-488-0129
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health