Provider Demographics
NPI:1568722593
Name:BERARDI, ANNA A (PHD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:A
Last Name:BERARDI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15930 SW STRATFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-5556
Mailing Address - Country:US
Mailing Address - Phone:503-639-4404
Mailing Address - Fax:
Practice Address - Street 1:15930 SW STRATFORD LOOP
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-5556
Practice Address - Country:US
Practice Address - Phone:503-639-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1710101YP2500X
CAMFC31103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist