Healthcare Provider Details

I. General information

NPI: 1932206844
Provider Name (Legal Business Name): ROBERT BERNARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 MARION STREET
BELLMORE NY
11710
US

IV. Provider business mailing address

2737 MARION STREET
BELLMORE NY
11710
US

V. Phone/Fax

Practice location:
  • Phone: 516-557-4019
  • Fax: 516-783-0480
Mailing address:
  • Phone: 516-557-4019
  • Fax: 516-783-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0079221
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT BERNARD
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD PSYCHOLOGY
Phone: 516-557-4019