Provider Demographics
NPI:1861519654
Name:BERNE, PATRICIA EGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:EGAN
Last Name:BERNE
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 1:7710 CARONDELET AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3319
Mailing Address - Country:US
Mailing Address - Phone:314-725-0550
Mailing Address - Fax:314-725-1960
Practice Address - Street 1:7710 CARONDELET AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3319
Practice Address - Country:US
Practice Address - Phone:314-725-0550
Practice Address - Fax:314-725-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00856103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK24204Medicare ID - Type Unspecified