Provider Demographics
NPI:1144592965
Name:TORNBERG, ANTOINETTE (MFT)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:TORNBERG
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 1:50 EDENBROOK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1277
Mailing Address - Country:US
Mailing Address - Phone:949-271-6325
Mailing Address - Fax:949-271-6335
Practice Address - Street 1:15615 ALTON PKWY
Practice Address - Street 2:SUITE 450
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3341
Practice Address - Country:US
Practice Address - Phone:949-271-6325
Practice Address - Fax:949-271-6335
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist