Provider Demographics
NPI:1992875108
Name:BERNSTEIN, PAULA (PHD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BERNSTEIN
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 1:318 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3113
Mailing Address - Country:US
Mailing Address - Phone:212-348-4868
Mailing Address - Fax:212-348-4868
Practice Address - Street 1:111 LAKE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3935
Practice Address - Country:US
Practice Address - Phone:914-793-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02706247Medicaid
NY02706247Medicaid