Provider Demographics
NPI:1326115759
Name:BERNAL, LUDMILLA MATTOS (ASW)
Entity Type:Individual
Prefix:MS
First Name:LUDMILLA
Middle Name:MATTOS
Last Name:BERNAL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7447
Mailing Address - Country:US
Mailing Address - Phone:805-588-2010
Mailing Address - Fax:
Practice Address - Street 1:110 S C ST STE A
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7340
Practice Address - Country:US
Practice Address - Phone:805-735-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20278104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker