Doctor Name: | DR. SUSAN TRESE BERNADETT |
NPI Number: | 1134230303 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY15196 |
Business Practice Address: | 4546 El Camino Real Ste 242 Los Altos, CA - 940221069 |
Business Phone Number: | 6509487292 |
Business Fax Number: | 6509481464 |
Mailing Address: | 385 Verano Dr, LOS ALTOS |
State: | CA |
Postal Code: | 940222345 |
Phone Number: | 6509487292 |
Fax Number: | 6509481464 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | PSY15196 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |