Provider Demographics
NPI:1164439600
Name:BERNSTEIN, WILLIAM MORRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MORRIS
Last Name:BERNSTEIN
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 1:1435 S SAINT FRANCIS DR BLDG SUITE209
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4202
Mailing Address - Country:US
Mailing Address - Phone:505-977-4523
Mailing Address - Fax:505-503-7897
Practice Address - Street 1:1435 S SAINT FRANCIS DR BLDG SUITE209
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4202
Practice Address - Country:US
Practice Address - Phone:505-977-4523
Practice Address - Fax:505-503-7897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0882103TC0700X
NM0012C103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48250538Medicaid