MEDICARE: REBECCA J BERNAS, PSYD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY5865	FL

General Provider Information

NPI Number	:	1629305628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA J BERNAS, PSYD, PLLC

Provider Business Mailing Address
First Line	:	1560 MATTHEW DR
Second Line	:	UNIT F
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1702
Country	:	US
Telephone Number	:	239-274-7793
Fax Number	:	239-277-1993

Provider Business Practice Location Address
First Line	:	1560 MATTHEW DR
Second Line	:	UNIT F
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1702
Country	:	US
Telephone Number	:	239-274-7793
Fax Number	:	239-277-1993

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REBECCA J BERNAS
Credential	:	PSY.D.
Telephone Number	:	239-274-7793

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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