Healthcare Provider Details

I. General information

NPI: 1780612309
Provider Name (Legal Business Name): EILEEN F BERNAT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E INTERCITY AVE SUITE A
EVERETT WA
98208-2751
US

IV. Provider business mailing address

127 E INTERCITY AVE SUITE A
EVERETT WA
98208-2751
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-7275
  • Fax: 425-355-0626
Mailing address:
  • Phone: 425-347-7275
  • Fax: 425-355-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1738
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: