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General NPI Number Information
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NPI Number | 1942373949
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Entity Type | Individual
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Provider Name | STACEY BERARDINO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 517 N MAIN ST
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City | SANTA ANA
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State | CA
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Zip | 92701-4619
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Country | US
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Telephone | 714-568-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 26895 ALISO CREEK RD STE B # 627
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5302
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Country | US
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Telephone | 949-235-4874
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 17545
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License Number State | CA
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