Healthcare Provider Details

I. General information

NPI: 1194990150
Provider Name (Legal Business Name): ROBERTA BERNITT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-30 CLYDE ST. -SUITE A
NEW YORK NY
11375
US

IV. Provider business mailing address

6730 CLYDE ST SUITE 2A
FOREST HILLS NY
11375-4055
US

V. Phone/Fax

Practice location:
  • Phone: 917-558-5355
  • Fax: 718-520-0671
Mailing address:
  • Phone: 917-558-5355
  • Fax: 718-520-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberR047904
License Number StateNY

VIII. Authorized Official

Name: PROF. ROBERTA BERNITT
Title or Position: OWNER
Credential: LCSW-R
Phone: 917-558-5355