Provider Demographics
NPI:1346696960
Name:GLEASON, BERNADINE (LMFT)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BERNIE
Other - Middle Name:
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1633 ERRINGER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3583
Mailing Address - Country:US
Mailing Address - Phone:470-236-9565
Mailing Address - Fax:
Practice Address - Street 1:1633 ERRINGER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3583
Practice Address - Country:US
Practice Address - Phone:470-236-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT89079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist