Provider Demographics
NPI:1780990697
Name:BERNACKY, LAURA IRENE (PSY D, HSPP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:IRENE
Last Name:BERNACKY
Suffix:
Gender:F
Credentials:PSY D, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6385
Mailing Address - Country:US
Mailing Address - Phone:219-757-1939
Mailing Address - Fax:
Practice Address - Street 1:8400 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6385
Practice Address - Country:US
Practice Address - Phone:219-757-1939
Practice Address - Fax:219-757-1950
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042411A103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service