Provider Demographics
NPI:1225380512
Name:BERNAL, ELISA (AMFT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:CARDOSO-HURTADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:864 E SANTA CLARA STREET
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001
Mailing Address - Country:US
Mailing Address - Phone:805-643-1446
Mailing Address - Fax:805-482-0987
Practice Address - Street 1:864 E SANTA CLARA STREET
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-643-1446
Practice Address - Fax:805-482-0987
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2020-04-15
Deactivation Date:2018-07-18
Deactivation Code:
Reactivation Date:2020-04-15
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CAAMFT112571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst