MEDICARE: CHRISTINA BERDEBES PHD, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT3896	FL

General Provider Information

NPI Number	:	1265039168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA BERDEBES PHD, LMFT

Provider Business Mailing Address
First Line	:	11123 76TH RD APT C5
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 76TH RD APT C5
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6434
Country	:	US
Telephone Number	:	305-282-5821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2020
Last Update Date	:	10/04/2020

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