Healthcare Provider Details

I. General information

NPI: 1225879315
Provider Name (Legal Business Name): LAUREN BERNSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SUFFIELD ST
AGAWAM MA
01001-1721
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 413-264-5492
  • Fax: 413-264-5493
Mailing address:
  • Phone: 603-410-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102902
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: