Provider Demographics
NPI:1033305396
Name:CARBERRY, PATRICIA ANN (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:CARBERRY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10902 HARTSOOK ST APT 201
Mailing Address - Street 2:
Mailing Address - City:N. HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3963
Mailing Address - Country:US
Mailing Address - Phone:818-506-7393
Mailing Address - Fax:
Practice Address - Street 1:10902 HARTSOOK ST APT 201
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3963
Practice Address - Country:US
Practice Address - Phone:818-506-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health