MEDICARE: CRISTINE JOANN BERENSOHN MG61629412

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	MG61629412	WA

General Provider Information

NPI Number	:	1720898877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINE JOANN BERENSOHN MG61629412

Provider Business Mailing Address
First Line	:	7225 SE OVERAA RD
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-8684
Country	:	US
Telephone Number	:	206-940-9209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2497 BETHEL RD SE STE 201
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2489
Country	:	US
Telephone Number	:	360-919-5350
Fax Number	:

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

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	01/10/2025

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