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General NPI Number Information
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NPI Number | 1689960411
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Entity Type | Individual
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Provider Name | MICHELLE D BORNSTEIN PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 501 WASHBURN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40222-4725
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Country | US
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Telephone | 213-842-9342
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 SYLVAN WYNDE
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City | LOUISVILLE
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State | KY
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Zip | 40205-2477
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Country | US
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Telephone | 213-842-9342
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 016990
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1725
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License Number State | KY
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