Healthcare Provider Details

I. General information

NPI: 1710319629
Provider Name (Legal Business Name): BERNHARD HEINRICH HERLYN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801
US

IV. Provider business mailing address

200 HYGEIA DR STE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0001202
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: