Heather M Bernstein – Clinical Psychologist

Key facts

NPI: 1194239491
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Psychologist 103TC0700X
License: 003592 (CT)
Practice address: 175 Copse Rd
Madison, CT 06443
Phone: (203) 245-2778
NPI assigned: Nov 22, 2017
Sex: Female
Sole proprietor: Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Grove School Emotionally Disturbed Childrens' Residential Treatment Facility · Madison, CT · NPI 1801086830

NPD (past)
Larry Bilker, PH.D., LLC Psychologist · Guilford, CT · NPI 1053615534

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file
Opted out of Medicare: Previously, effective Aug 15, 2024 through Aug 15, 2026

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
003592	CT	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Larry Bilker, PH.D., LLC		Past	Accepting new patients
Grove School		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Psychologist	103TC0700X	003592	CT	Yes

Addresses

Primary practice location

175 Copse Rd
Madison, CT 06443

Mailing address

175 Copse Rd
Madison, CT 06443-2323
Phone (203) 245-2778

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 30, 2018.

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1194239491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 COPSE RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432323",
            "telephone_number": "203-245-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 COPSE RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "06443",
            "telephone_number": "203-245-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNSTEIN",
        "first_name": "HEATHER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-22",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "003592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, CT

All providers in Madison, CT · Clinical Psychologist in Connecticut

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Opt Out Affidavits (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.