Provider Demographics
NPI:1255527420
Name:BERNARDES, CARLA M (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:M
Last Name:BERNARDES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 BEACON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4905
Mailing Address - Country:US
Mailing Address - Phone:617-232-2436
Mailing Address - Fax:
Practice Address - Street 1:1371 BEACON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4905
Practice Address - Country:US
Practice Address - Phone:617-232-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical