Provider Demographics
NPI:1760681050
Name:TAK, BERNICE NARY (PHD)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:NARY
Last Name:TAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BERNICE
Other - Middle Name:NARY
Other - Last Name:JOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2422 6TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7803
Mailing Address - Country:US
Mailing Address - Phone:213-840-9810
Mailing Address - Fax:
Practice Address - Street 1:2422 6TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7803
Practice Address - Country:US
Practice Address - Phone:213-712-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23103103TC0700X
NJ35SI00687600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical