Healthcare Provider Details

I. General information

NPI: 1790844025
Provider Name (Legal Business Name): MARTIN E BERNSTEIN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S WADSWORTH BLVD BLDG 2 102
LAKEWOOD CO
80226-4300
US

IV. Provider business mailing address

777 S WADSWORTH BLVD BLDG 2 102
LAKEWOOD CO
80226-4300
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-1520
  • Fax: 303-989-1520
Mailing address:
  • Phone: 303-989-1520
  • Fax: 303-989-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number456
License Number StateCO

VIII. Authorized Official

Name: DR. MARTIN BERNSTEIN
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 303-989-1520