Provider Demographics
NPI:1063680684
Name:BERARDI, JEAN DIANE (MED,LMFT,LMHC,CT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:DIANE
Last Name:BERARDI
Suffix:
Gender:F
Credentials:MED,LMFT,LMHC,CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2332
Mailing Address - Country:US
Mailing Address - Phone:617-240-4975
Mailing Address - Fax:781-272-0349
Practice Address - Street 1:27 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2332
Practice Address - Country:US
Practice Address - Phone:617-240-4975
Practice Address - Fax:781-272-0349
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health