Basic Information
| Provider Information | |||||||||
| NPI: | 1932180718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKAY | ||||||||
| FirstName: | BERNICE | ||||||||
| MiddleName: | GAYLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 LIBERTY ST | ||||||||
| Address2: | YALE PSYCHIATRIC INSTITUTE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036889920 | ||||||||
| FaxNumber: | 2037372221 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 LIBERTY ST | ||||||||
| Address2: | YALE PSYCHIATRIC INSTITUTE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036889920 | ||||||||
| FaxNumber: | 2037372221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 000215 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 004204442 | 05 | CT | MEDICAID |