Provider Demographics
NPI:1043971971
Name:BERNARDO, LORAINE DOMINIQUE REYES (AMFT #129047)
Entity Type:Individual
Prefix:
First Name:LORAINE DOMINIQUE
Middle Name:REYES
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:AMFT #129047
Other - Prefix:
Other - First Name:LORAINE
Other - Middle Name:REYES
Other - Last Name:BERNARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-8702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6536 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1192
Practice Address - Country:US
Practice Address - Phone:510-496-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty