Provider Demographics
NPI:1487265526
Name:BERNFELD, MEREDITH L (PHD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:BERNFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OCEAN PARKWAY
Mailing Address - Street 2:SUITE 1P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2589
Mailing Address - Country:US
Mailing Address - Phone:646-970-2330
Mailing Address - Fax:
Practice Address - Street 1:135 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2567
Practice Address - Country:US
Practice Address - Phone:646-970-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023777103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist