Provider Demographics
NPI:1528029931
Name:BERNELL, MONICA DORIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:DORIS
Last Name:BERNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MILL STREET
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4744
Mailing Address - Country:US
Mailing Address - Phone:781-523-5636
Mailing Address - Fax:781-532-4220
Practice Address - Street 1:22 MILL STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4744
Practice Address - Country:US
Practice Address - Phone:781-523-5636
Practice Address - Fax:781-532-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51139Medicare ID - Type Unspecified