Provider Demographics
NPI:1982953931
Name:BERNARDO, KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:BERNARDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 DOUGLAS AVE
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5845
Mailing Address - Country:US
Mailing Address - Phone:214-361-2622
Mailing Address - Fax:214-361-8649
Practice Address - Street 1:8333 DOUGLAS AVE
Practice Address - Street 2:SUITE 1240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5845
Practice Address - Country:US
Practice Address - Phone:214-361-2622
Practice Address - Fax:214-361-8649
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical