Active NPI
Douglas B. Bernon, PH.D., PH.D.
- Clinical Psychologist
- Portsmouth, RI
National Provider Identifier
1578709176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 425
- Practice address
- 13 Baker Rd
Portsmouth, RI 02871-1708 - Phone
- (401) 293-0343
- NPI assigned
- Jan 2, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 425 | RI | Primary |
| Psychoanalysis Psychologist | 103TP0814X | 425 | RI |
Addresses
Primary practice location
13 Baker Rd
Portsmouth, RI 02871-1708
Mailing address
13 Baker Rd
Portsmouth, RI 02871-1708
Phone (401) 293-0343
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42653 | Other | COUNCIL FOR THE NATIONAL REGISTER OF HEALTH SERVICE PROVIDERS IN PSYCHOLOGY | |
| LICENSE 425 | Other | RI | STATE OF RHODE ISLAND DEPARTMENT OF HEALTH |
| 3609-8192 | Other | AMERICAN PSYCHOLOGICAL ASSOCIATION |
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 |
|---|---|---|---|
| 425 | RI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1578709176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 BAKER RD",
"city": "PORTSMOUTH",
"state": "RI",
"postal_code": "028711708",
"telephone_number": "401-293-0343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13 BAKER RD",
"city": "PORTSMOUTH",
"state": "RI",
"postal_code": "028711708",
"telephone_number": "401-293-0343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNON",
"first_name": "DOUGLAS",
"middle_name": "B.",
"name_prefix": "Dr.",
"credential": "PH.D., PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-02",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "RI",
"license": "425",
"primary": true
},
{
"code": "103TP0814X",
"taxonomy_group": "",
"desc": "Psychologist, Psychoanalysis",
"state": "RI",
"license": "425",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNCIL FOR THE NATIONAL REGISTER OF HEALTH SERVICE PROVIDERS IN PSYCHOLOGY",
"identifier": "42653",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF RHODE ISLAND DEPARTMENT OF HEALTH",
"identifier": "LICENSE 425",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN PSYCHOLOGICAL ASSOCIATION",
"identifier": "3609-8192",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.