Provider Demographics
NPI:1821377433
Name:BERL, DEBRA RANDI (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RANDI
Last Name:BERL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:BERL-HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4550 KEARNY VILLA RD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1583
Mailing Address - Country:US
Mailing Address - Phone:619-672-8893
Mailing Address - Fax:
Practice Address - Street 1:4550 KEARNY VILLA RD STE 116
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1583
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175641041C0700X
CA175641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical