Provider Demographics
NPI:1407049869
Name:BERTONE, MARC RICHARD (MA JD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:RICHARD
Last Name:BERTONE
Suffix:
Gender:M
Credentials:MA JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25283 CABOT ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-683-0412
Mailing Address - Fax:
Practice Address - Street 1:25283 CABOT ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-683-0412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist