Healthcare Provider Details

I. General information

NPI: 1528543980
Provider Name (Legal Business Name): DANIELLA KARINA BERMUDEZ AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 PACHECO ST
CONCORD CA
94520-2309
US

IV. Provider business mailing address

PO BOX 124
CONCORD CA
94522-0124
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5410
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1088343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: