Provider Demographics
NPI:1891383279
Name:BERNARD, NICOLA (PHD LP)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PHD LP
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 201161
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-9161
Mailing Address - Country:US
Mailing Address - Phone:248-289-3311
Mailing Address - Fax:
Practice Address - Street 1:615 GARDENDALE ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2487
Practice Address - Country:US
Practice Address - Phone:949-295-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018745103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist