Provider Demographics
NPI:1164560744
Name:BERLIN, ADRIENNE FAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:FAYE
Last Name:BERLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 TYRIAN ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6150
Mailing Address - Country:US
Mailing Address - Phone:619-251-3877
Mailing Address - Fax:858-790-3745
Practice Address - Street 1:7946 IVANHOE AVE
Practice Address - Street 2:SUITE NUMBER 205
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4516
Practice Address - Country:US
Practice Address - Phone:619-251-3877
Practice Address - Fax:858-790-3745
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS138521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW13852Medicare ID - Type Unspecified