MEDICARE: MS. DOROTHY JEANNE BERNDT LCSW

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	1041C0700X	Clinical Social Worker	LCS 4636	CA

General Provider Information

NPI Number	:	1528082377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY JEANNE BERNDT LCSW

Provider Business Mailing Address
First Line	:	3760 MOTOR AVE
Second Line	:	SUITE #311
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6404
Country	:	US
Telephone Number	:	310-374-7905
Fax Number	:	310-374-7905

Provider Business Practice Location Address
First Line	:	3760 MOTOR AVE
Second Line	:	SUITE #311
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6404
Country	:	US
Telephone Number	:	310-374-7905
Fax Number	:	310-374-7905

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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