Provider Demographics
NPI:1891783288
Name:BERNET, CHRISTINE (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BERNET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2015
Mailing Address - Country:US
Mailing Address - Phone:619-699-8443
Mailing Address - Fax:619-237-9499
Practice Address - Street 1:2031 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2015
Practice Address - Country:US
Practice Address - Phone:619-699-8443
Practice Address - Fax:619-237-9499
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15679103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY15679Medicaid
CACP15679Medicare ID - Type Unspecified