Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS2791L | PA |
Y | 103TC0700X | Clinical Psychologist | PS2791L | PA |
NPI | 1013003441 |
---|---|
Provider Name | Elliot Harvey Bern |
First Address | Matamoras, PA 18336-1713 |
Second Address | Matamoras, PA 18336-1713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |