Provider Demographics
NPI:1225283492
Name:BERNOVICH, DONALD LEE II (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:BERNOVICH
Suffix:II
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:1101 E 78TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1400
Practice Address - Country:US
Practice Address - Phone:952-854-5034
Practice Address - Fax:952-854-5363
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2016-04-04
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Provider Licenses
StateLicense IDTaxonomies
MNLP5949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical