Provider Demographics
NPI:1053766139
Name:BERNARD, LARRY C (PHD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:C
Last Name:BERNARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 W SUNSET BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2311
Mailing Address - Country:US
Mailing Address - Phone:323-388-5846
Mailing Address - Fax:
Practice Address - Street 1:8560 W SUNSET BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-2311
Practice Address - Country:US
Practice Address - Phone:323-388-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7167103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist