Provider Demographics
NPI:1275914129
Name:BORNSTEIN, BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 N GOLF DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2461
Mailing Address - Country:US
Mailing Address - Phone:414-813-8989
Mailing Address - Fax:
Practice Address - Street 1:8989 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BAYSIDE
Practice Address - State:WI
Practice Address - Zip Code:53217-1671
Practice Address - Country:US
Practice Address - Phone:414-813-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1680-57103T00000X, 103TS0200X
WI1680-057103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool