Provider Demographics
NPI:1417014754
Name:BERKANA, JESSICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BERKANA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:884 3RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4533
Mailing Address - Country:US
Mailing Address - Phone:707-205-9670
Mailing Address - Fax:707-861-3631
Practice Address - Street 1:884 3RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4533
Practice Address - Country:US
Practice Address - Phone:707-205-9670
Practice Address - Fax:707-861-3631
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA47647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health