Provider Demographics
NPI:1770591208
Name:BERNSTEIN, MEREDITH (PHD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:BERNSTEIN
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 1:139 MAIN ST
Mailing Address - Street 2:ROOM 612
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3040
Mailing Address - Country:US
Mailing Address - Phone:802-257-2778
Mailing Address - Fax:
Practice Address - Street 1:139 MAIN ST
Practice Address - Street 2:ROOM 612
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3040
Practice Address - Country:US
Practice Address - Phone:802-257-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN 2475Medicaid
VTOVN 2475Medicaid