Provider Demographics
NPI:1083781041
Name:BERNER, JOHN LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:BERNER
Suffix:
Gender:M
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:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247
Mailing Address - Country:US
Mailing Address - Phone:209-728-8814
Mailing Address - Fax:
Practice Address - Street 1:366 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MURPHYS
Practice Address - State:CA
Practice Address - Zip Code:95247
Practice Address - Country:US
Practice Address - Phone:209-728-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical