Active NPI
Elliot Harvey Bern, PHD
- Clinical Psychologist
- Matamoras, PA
National Provider Identifier
1013003441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS2791L
- Practice address
- 1011 Pennsylvania Ave
Matamoras, PA 18336-1713 - Phone
- (570) 491-4728
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS2791L | PA | Primary |
Addresses
Primary practice location
1011 Pennsylvania Ave
Matamoras, PA 18336-1713
Mailing address
1011 Pennsylvania Ave
PO Box 188
Matamoras, PA 18336-1713
Phone (570) 491-4728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS2791L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013003441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 PENNSYLVANIA AVE",
"address_2": "PO BOX 188",
"city": "MATAMORAS",
"state": "PA",
"postal_code": "183361713",
"telephone_number": "570-491-4728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 PENNSYLVANIA AVE",
"city": "MATAMORAS",
"state": "PA",
"postal_code": "183361713",
"telephone_number": "570-491-4728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERN",
"first_name": "ELLIOT",
"middle_name": "HARVEY",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS2791L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Matamoras, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.