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General NPI Number Information
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NPI Number | 1578709176
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Entity Type | Individual
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Provider Name | DOUGLAS B. BERNON PH.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 13 BAKER RD
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1708
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Country | US
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Telephone | 401-293-0343
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BAKER RD
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1708
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Country | US
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Telephone | 401-293-0343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 425
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | 425
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License Number State | RI
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