Healthcare Provider Details

I. General information

NPI: 1528117074
Provider Name (Legal Business Name): LARRY A. BERENT MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 RALSTON ST FL 2
VENTURA CA
93003-6010
US

IV. Provider business mailing address

5810 RALSTON ST FL 2
VENTURA CA
93003-6010
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-7033
  • Fax: 805-642-7732
Mailing address:
  • Phone: 805-642-7033
  • Fax: 805-642-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS9331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: