Provider Demographics
NPI:1578015673
Name:BERNSTEIN, CARLA LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LYNN
Last Name:BERNSTEIN
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 1:200 N 16TH ST PH 22
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1225
Mailing Address - Country:US
Mailing Address - Phone:315-391-9056
Mailing Address - Fax:
Practice Address - Street 1:1225 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1929
Practice Address - Country:US
Practice Address - Phone:718-430-3907
Practice Address - Fax:718-904-1162
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022735103TC0700X
PAPS019647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical