Provider Demographics
NPI:1568847697
Name:BERNHARDT, JAMES (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BERNHARDT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E DEL MAR BLVD
Mailing Address - Street 2:APT. 117
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4718
Mailing Address - Country:US
Mailing Address - Phone:626-795-3516
Mailing Address - Fax:
Practice Address - Street 1:2330 E DEL MAR BLVD
Practice Address - Street 2:APT. 117
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4718
Practice Address - Country:US
Practice Address - Phone:626-795-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24336106H00000X
CAPSY11365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist