Provider Demographics
NPI:1083751960
Name:PONCE, CARLOS ALBERTO (LMFT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:PONCE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:ALBERTO
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:09/30/1954
Mailing Address - Street 1:2512 TELEGRAPH AVE # 135
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2918
Mailing Address - Country:US
Mailing Address - Phone:510-978-0353
Mailing Address - Fax:
Practice Address - Street 1:2512 TELEGRAPH AVE # 135
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2918
Practice Address - Country:US
Practice Address - Phone:510-978-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist