Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY14504 | CA |
Y | 103T00000X | Psychologist | PSY14504 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY14504 | CA |
N | 103G00000X | Clinical Psychologist | PSY14504 | CA |
N | 103TC0700X | Clinical Psychologist | PSY14504 | CA |
N | 103TC1900X | Counseling Psychologist | PSY14504 | CA |
NPI | 1235293481 |
---|---|
Provider Name | Robert Louis Bernatz |
First Address | Newport Beach, CA 92658-8683 |
Second Address | Newport Beach, CA 92663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 29/11/2011 |