Provider Demographics
NPI:1467830034
Name:JOHN A. BERADINO, PH.D, INC.
Entity Type:Organization
Organization Name:JOHN A. BERADINO, PH.D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BERADINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-500-6862
Mailing Address - Street 1:15233 VENTURA BLVD
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2201
Mailing Address - Country:US
Mailing Address - Phone:310-500-6862
Mailing Address - Fax:
Practice Address - Street 1:15233 VENTURA BLVD
Practice Address - Street 2:SUITE 1204
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2201
Practice Address - Country:US
Practice Address - Phone:310-500-6862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty