Provider Demographics
NPI:1386481513
Name:BERNSTEIN, EMILY (CCHW, BCPA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:CCHW, BCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25459
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-0459
Mailing Address - Country:US
Mailing Address - Phone:616-566-5087
Mailing Address - Fax:
Practice Address - Street 1:55 CROMWELL ST STE 1B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2569
Practice Address - Country:US
Practice Address - Phone:401-329-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI201532172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker