Provider Demographics
NPI:1700038494
Name:HERNANDEZ-BERRY, TINA L (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:HERNANDEZ-BERRY
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 I ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4428
Mailing Address - Country:US
Mailing Address - Phone:916-583-8149
Mailing Address - Fax:
Practice Address - Street 1:3020 I ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4428
Practice Address - Country:US
Practice Address - Phone:916-583-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50032106H00000X
CA305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional