Provider Demographics
NPI:1396882445
Name:BERNOU, ELEA (PSYD)
Entity type:Individual
Prefix:
First Name:ELEA
Middle Name:
Last Name:BERNOU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 MT DIABLO BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3602
Mailing Address - Country:US
Mailing Address - Phone:925-299-1056
Mailing Address - Fax:
Practice Address - Street 1:3744 MT DIABLO BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3602
Practice Address - Country:US
Practice Address - Phone:925-299-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16226103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL162260Medicare ID - Type Unspecified