Provider Demographics
NPI:1639357486
Name:BERNSTEIN, VICTOR J (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 W WAVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4949
Mailing Address - Country:US
Mailing Address - Phone:773-935-7582
Mailing Address - Fax:773-702-5352
Practice Address - Street 1:2045 W WAVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4949
Practice Address - Country:US
Practice Address - Phone:773-935-7582
Practice Address - Fax:773-702-5352
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent