Provider Demographics
NPI:1720020159
Name:BERARD, MICHAEL (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BERARD
Suffix:
Gender:M
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52612
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2612
Mailing Address - Country:US
Mailing Address - Phone:337-233-7867
Mailing Address - Fax:337-235-7199
Practice Address - Street 1:601 W SAINT MARY BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3568
Practice Address - Country:US
Practice Address - Phone:337-233-7867
Practice Address - Fax:337-235-7199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMPAP.000010103TP0016X, 103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1929191Medicaid
LA59421Medicare PIN