Provider Demographics
NPI:1598202285
Name:SCHAEFER, BERNICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MEMORIAL RD
Mailing Address - Street 2:UNIT 213
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2440
Mailing Address - Country:US
Mailing Address - Phone:860-521-1365
Mailing Address - Fax:
Practice Address - Street 1:85 MEMORIAL RD
Practice Address - Street 2:UNIT 213
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2440
Practice Address - Country:US
Practice Address - Phone:860-521-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist