Provider Demographics
NPI:1427217934
Name:BERNSTEIN, AMANDA JILL
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JILL
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 BERTHA DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5006
Mailing Address - Country:US
Mailing Address - Phone:516-546-6818
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE STE 211
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3620
Practice Address - Country:US
Practice Address - Phone:516-226-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019134-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWVE061OtherAGENCY MEDICARE ID #
NY1285628552OtherAGENCY NPI #
NY00355940OtherAGENCY MEDICAID PROVIDER ID
NY019134-1OtherNEW YORK STATE PSYCHOLOGIST LICENSE