Provider Demographics
NPI:1801017900
Name:BERNAT, SUSANNA G (PSYD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:G
Last Name:BERNAT
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 1:2340 WARD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1146
Mailing Address - Country:US
Mailing Address - Phone:510-944-8809
Mailing Address - Fax:
Practice Address - Street 1:2340 WARD ST STE 104
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1146
Practice Address - Country:US
Practice Address - Phone:512-868-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20734103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613267Medicare PIN