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General NPI Number Information
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NPI Number | 1467830034
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Entity Type | Organization
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Legal Business Name | JOHN A. BERADINO, PH.D, INC.
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 15233 VENTURA BLVD SUITE 1204
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2201
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Country | US
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Telephone | 310-500-6862
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Fax |
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Provider Business Mailing Address
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Address Line | 15233 VENTURA BLVD SUITE 1204
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2201
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Country | US
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Telephone | 310-500-6862
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JOHN ANTHONY BERADINO JR.
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Credential | PH.D.
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Telephone | 310-500-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PSY27226
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License Number State | CA
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