Provider Demographics
NPI:1508877044
Name:BERNHARDT, ALAN JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:BERNHARDT
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:NORTHAMPTON VA MEDICAL CENTER
Mailing Address - Street 2:421 N. MAIN STREET
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9700
Mailing Address - Country:US
Mailing Address - Phone:413-584-4040
Mailing Address - Fax:413-582-3137
Practice Address - Street 1:421 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9700
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:413-582-3137
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008359-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical