Provider Demographics
NPI:1164715728
Name:BERMAN, JACQUELINE K (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:K
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13344 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4834
Mailing Address - Country:US
Mailing Address - Phone:818-371-6117
Mailing Address - Fax:818-788-4951
Practice Address - Street 1:16055 VENTURA BLVD STE 1111
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2612
Practice Address - Country:US
Practice Address - Phone:818-371-6117
Practice Address - Fax:818-788-4951
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist