Provider Demographics
NPI:1548153125
Name:BERNSTEIN, ELIZABETH JAYDE (101YM0800X)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JAYDE
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:101YM0800X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-3132
Mailing Address - Country:US
Mailing Address - Phone:772-284-5776
Mailing Address - Fax:
Practice Address - Street 1:5605 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-3132
Practice Address - Country:US
Practice Address - Phone:772-284-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health