Provider Demographics
NPI:1700817020
Name:BERLIN, IRENE E (MFT)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:E
Last Name:BERLIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 AVENUE I
Mailing Address - Street 2:#28
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5619
Mailing Address - Country:US
Mailing Address - Phone:310-316-7800
Mailing Address - Fax:310-792-0645
Practice Address - Street 1:205 AVENUE I
Practice Address - Street 2:#28
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5619
Practice Address - Country:US
Practice Address - Phone:310-316-7800
Practice Address - Fax:310-792-0645
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT19918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health