Healthcare Provider Details

I. General information

NPI: 1871680710
Provider Name (Legal Business Name): TERESITA BERNDES-CARLSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESITA B BERNDES

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 7TH STREET # 201
SANTA MONICA CA
90401
US

IV. Provider business mailing address

3831 HUGHES AVE STE 708
CULVER CITY CA
90232-6842
US

V. Phone/Fax

Practice location:
  • Phone: 310-838-4403
  • Fax: 310-395-4146
Mailing address:
  • Phone: 310-838-4403
  • Fax: 888-231-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT23575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: