Provider Demographics
NPI:1588735054
Name:BERNSTEIN, AUDREY (MS)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 FITCH'S PASS
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5602
Mailing Address - Country:US
Mailing Address - Phone:203-261-8671
Mailing Address - Fax:
Practice Address - Street 1:232 FITCH'S PASS
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5602
Practice Address - Country:US
Practice Address - Phone:203-261-8671
Practice Address - Fax:203-261-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist