Basic Information
Provider Information
NPI: 1770783987
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERARD
FirstName: HILLARY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 INLAND DR
Address2:  
City: VERNON
State: CT
PostalCode: 060664305
CountryCode: US
TelephoneNumber: 8608718275
FaxNumber:  
Practice Location
Address1: 587 E MIDDLE TPKE
Address2:  
City: MANCHESTER
State: CT
PostalCode: 060403731
CountryCode: US
TelephoneNumber: 8606463888
FaxNumber: 8606454132
Other Information
ProviderEnumerationDate: 07/25/2007
LastUpdateDate: 07/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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