Provider Demographics
NPI:1609346113
Name:BERNABE, TATUM SUZZANNE (RADT)
Entity Type:Individual
Prefix:
First Name:TATUM
Middle Name:SUZZANNE
Last Name:BERNABE
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5218
Mailing Address - Country:US
Mailing Address - Phone:831-899-2436
Mailing Address - Fax:831-899-7405
Practice Address - Street 1:1152 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5218
Practice Address - Country:US
Practice Address - Phone:831-899-2436
Practice Address - Fax:831-899-7405
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1329681118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)