Provider Demographics
NPI:1811220478
Name:BERESFORD, ROBIN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:BERESFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 THE ALAMEDA
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1122
Mailing Address - Country:US
Mailing Address - Phone:408-879-8234
Mailing Address - Fax:408-248-9762
Practice Address - Street 1:2160 THE ALAMEDA
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1122
Practice Address - Country:US
Practice Address - Phone:408-879-8234
Practice Address - Fax:408-248-9762
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist