Provider Demographics
NPI:1073872362
Name:BERMUDEZ ROGERS, EMERALD ANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:EMERALD
Middle Name:ANNE
Last Name:BERMUDEZ ROGERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:EMERALD
Other - Middle Name:ANN
Other - Last Name:BERMUDEZ ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4346 ALDERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-0807
Mailing Address - Country:US
Mailing Address - Phone:916-572-3277
Mailing Address - Fax:
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6591
Practice Address - Country:US
Practice Address - Phone:530-747-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103K00000X
CA96682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty