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Individual

DR. DOUGLAS B. BERNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D., PH.D.

Contact information

Practice address
13 BAKER RD, PORTSMOUTH, RI 02871-1708
(401) 293-0343
Mailing address
13 BAKER RD, PORTSMOUTH, RI 02871-1708
(401) 293-0343

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
425
RI
103TP0814X
Psychoanalysis Psychologist
425
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3609-8192
AMERICAN PSYCHOLOGICAL ASSOCIATION
01
42653
COUNCIL FOR THE NATIONAL REGISTER OF HEALTH SERVICE PROVIDERS IN PSYCHOLOGY
01
LICENSE 425
STATE OF RHODE ISLAND DEPARTMENT OF HEALTH
RI
Enumeration date
01/02/2009
Last updated
03/02/2012
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