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General NPI Number Information
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NPI Number | 1275813214
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Entity Type | Individual
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Provider Name | SYDNEY ADOLFO BERRO MFT
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Gender | Male
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 16170 MAIN STREET
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City | LOWER LAKE
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State | CA
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Zip | 95457
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Country | US
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Telephone | 707-272-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 816 ARLINGTON AVE
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City | BERKELEY
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State | CA
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Zip | 94707-1927
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Country | US
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Telephone | 707-272-2570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 72416
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License Number State | CA
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