Provider Demographics
NPI:1164408092
Name:BERNSTEIN, STACI FIELDS (LLP)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:FIELDS
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MS
Other - First Name:STACI
Other - Middle Name:MARIE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE UNDER THIS NAME
Mailing Address - Street 1:106 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1504
Mailing Address - Country:US
Mailing Address - Phone:248-322-6220
Mailing Address - Fax:248-322-6221
Practice Address - Street 1:15945 CANAL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1610
Practice Address - Country:US
Practice Address - Phone:586-416-2300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012630103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist