Provider Demographics
NPI:1235738501
Name:BERNSTEIN- SCHULTZ, MICHELLE ROSE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:BERNSTEIN- SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ROSE
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4910
Mailing Address - Country:US
Mailing Address - Phone:480-455-0671
Mailing Address - Fax:
Practice Address - Street 1:912 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4910
Practice Address - Country:US
Practice Address - Phone:480-455-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst