MEDICARE: ROBERTA BERNITT

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
1	302F00000X	Exclusive Provider Organization	R047904	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194990150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA BERNITT

Provider Business Mailing Address
First Line	:	6730 CLYDE ST
Second Line	:	SUITE 2A
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4055
Country	:	US
Telephone Number	:	917-558-5355
Fax Number	:	718-520-0671

Provider Business Practice Location Address
First Line	:	67-30 CLYDE ST. -SUITE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11375
Country	:	US
Telephone Number	:	917-558-5355
Fax Number	:	718-520-0671

Authorized Official
Title or Position	:	OWNER
Name	:	PROF. ROBERTA BERNITT
Credential	:	LCSW-R
Telephone Number	:	917-558-5355

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	02/03/2017

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