Bernadette M Charles, LISW LICDC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I1839 Issued in OH

Practice address

695 South St
Chardon, OH 44024-1474

Phone

(440) 286-1631

NPI assigned

Jan 11, 2008

Last updated

Jan 11, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ravenwood Mental Health Center

  • Addiction (Substance Use Disorder) Counselor
  • Chardon, OH
  • NPI 1912265794
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1538345335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 DENISE DR",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442401606",
            "telephone_number": "330-678-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 SOUTH ST",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440241474",
            "telephone_number": "440-286-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "BERNADETTE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LISW     LICDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-11",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "892705",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chardon Local School District
• Chardon Physical Therapy LLC
• Chardon Township (Chardon Fire Department)
• Chardon Woods of Journey LLC (Chardon Woods)
• Charles Cassady, M.D., Inc.
• Christina M Charlillo, LISW
• Kevin Michael Chartrand, M.D.
• Emily Man-Shan Chau, M.D.
• Christ-Roi Cheres, M.D.
• Jessica Chien, DO

• Clinical Social Worker in Chardon, OH
• Providers in Chardon, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.