Basic Information
| Provider Information | |||||||||
| NPI: | 1982738654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNATH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1521 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947031422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815290 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1521 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947031422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815290 | ||||||||
| FaxNumber: | 5104868014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY 16049 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.