Provider Demographics
NPI:1538343348
Name:BERNBAUM, SHELLEY (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:BERNBAUM
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:DONNA
Other - Last Name:BERNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:1275 S PATRICK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-543-3577
Mailing Address - Fax:
Practice Address - Street 1:1275 S PATRICK DR
Practice Address - Street 2:SUITE D
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-779-0213
Practice Address - Fax:321-773-0497
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health