Healthcare Provider Details

I. General information

NPI: 1972433316
Provider Name (Legal Business Name): RANDY BETH BERMAN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 VALE TERRACE DR
VISTA CA
92084-5213
US

IV. Provider business mailing address

1431 LINDA SUE LN
ENCINITAS CA
92024-2422
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-3505
  • Fax:
Mailing address:
  • Phone: 619-991-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1437379039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: