Provider Demographics
NPI:1508107962
Name:BERTO, ODALIS M (LCSW)
Entity Type:Individual
Prefix:
First Name:ODALIS
Middle Name:M
Last Name:BERTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1505
Mailing Address - Country:US
Mailing Address - Phone:818-726-4294
Mailing Address - Fax:
Practice Address - Street 1:30 N RAYMOND AVE STE 810
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-4479
Practice Address - Country:US
Practice Address - Phone:818-726-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 194811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical