Doctor Name: | DR. BERNS ROBERT MIMNAUGH |
NPI Number: | 1073660379 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 901 |
Business Practice Address: | 405 Pittsfield Rd Unit I-1 Lenox, MA - 012402901 |
Business Phone Number: | 4132365700 |
Business Fax Number: | 4132365701 |
Mailing Address: | 405 Pittsfield Rd, Unit I-1 LENOX |
State: | MA |
Postal Code: | 012402901 |
Phone Number: | 4132365700 |
Fax Number: | 4132365701 |
NPI Enumeration Date: | 01/05/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |