Healthcare Provider Details

I. General information

NPI: 1568847697
Provider Name (Legal Business Name): JAMES BERNHARDT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 E DEL MAR BLVD APT. 117
PASADENA CA
91107-4718
US

IV. Provider business mailing address

2330 E DEL MAR BLVD APT. 117
PASADENA CA
91107-4718
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-3516
  • Fax:
Mailing address:
  • Phone: 626-795-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT24336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: