Provider Demographics
NPI:1457506594
Name:BERRU, RUDOLFO J (MA,LMFT,CEAP)
Entity Type:Individual
Prefix:MR
First Name:RUDOLFO
Middle Name:J
Last Name:BERRU
Suffix:
Gender:M
Credentials:MA,LMFT,CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S VENICE BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4674
Mailing Address - Country:US
Mailing Address - Phone:310-306-9082
Mailing Address - Fax:323-586-3988
Practice Address - Street 1:408 S VENICE BLVD APT 2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4674
Practice Address - Country:US
Practice Address - Phone:310-306-9082
Practice Address - Fax:323-586-2615
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT #43334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist