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NPI Code Detail

MEDICARE: DR. SUSAN TRESE BERNADETT PH.D.

MEDICARE: DR. SUSAN TRESE BERNADETT PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent PsychologistPSY15196CA
2103T00000XPsychologistPSY15196CA

General Provider Information

NPI Number : 1134230303
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN TRESE BERNADETT PH.D.
Provider Business Mailing Address
First Line : 385 VERANO DR
Second Line :
City : LOS ALTOS
State : CA
Zip : 94022-2345
Country : US
Telephone Number : 650-948-7292
Fax Number : 650-948-1464
Provider Business Practice Location Address
First Line : 4546 EL CAMINO REAL STE 242
Second Line :
City : LOS ALTOS
State : CA
Zip : 94022-1069
Country : US
Telephone Number : 650-948-7292
Fax Number : 650-948-1464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/11/2025

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