Healthcare Provider Details

I. General information

NPI: 1861204190
Provider Name (Legal Business Name): NATALIA BERNAL FERNANDEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CARR 2 STE 500
GUAYNABO PR
00966-2049
US

IV. Provider business mailing address

97 CARR 2 STE 500
GUAYNABO PR
00966-2049
US

V. Phone/Fax

Practice location:
  • Phone: 208-486-7526
  • Fax:
Mailing address:
  • Phone: 208-486-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026299
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number026299
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number026299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: