Provider Demographics
NPI:1609515782
Name:BERNSTEIN, JENNIE (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
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 1:11001 W 120TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3493
Mailing Address - Country:US
Mailing Address - Phone:701-484-3751
Mailing Address - Fax:
Practice Address - Street 1:11001 W 120TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3493
Practice Address - Country:US
Practice Address - Phone:701-484-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical