Provider Demographics
NPI:1851891790
Name:BARDOVI, DENISE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:BARDOVI
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 WILKINS AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5837
Mailing Address - Country:US
Mailing Address - Phone:310-396-2440
Mailing Address - Fax:
Practice Address - Street 1:10661 WILKINS AVE APT 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5837
Practice Address - Country:US
Practice Address - Phone:310-396-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT32228OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCE