Provider Demographics
NPI:1407980766
Name:KERASIOTIS, BERNADINA (NPP PSYD)
Entity Type:Individual
Prefix:DR
First Name:BERNADINA
Middle Name:
Last Name:KERASIOTIS
Suffix:
Gender:F
Credentials:NPP PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LESTER AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5912
Mailing Address - Country:US
Mailing Address - Phone:516-672-5814
Mailing Address - Fax:631-370-1902
Practice Address - Street 1:65 LESTER AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5912
Practice Address - Country:US
Practice Address - Phone:516-672-5814
Practice Address - Fax:631-370-1902
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4007812084P0800X, 2084P0804X
NY4007812084P0804X
NY15521207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery