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General NPI Number Information
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NPI Number | 1720898877
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Entity Type | Individual
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Provider Name | CRISTINE JOANN BERENSOHN MG61629412
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 2497 BETHEL RD SE STE 201
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City | PORT ORCHARD
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State | WA
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Zip | 98366-2489
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Country | US
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Telephone | 360-919-5350
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Fax |
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Provider Business Mailing Address
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Address Line | 7225 SE OVERAA RD
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City | PORT ORCHARD
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State | WA
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Zip | 98367-8684
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Country | US
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Telephone | 206-940-9209
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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 | MG61629412
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License Number State | WA
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