Provider Demographics
NPI:1942220801
Name:BERNABO, JANET LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:LEE
Last Name:BERNABO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 CAMINITO SANUDO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2103
Mailing Address - Country:US
Mailing Address - Phone:858-549-0542
Mailing Address - Fax:858-549-3146
Practice Address - Street 1:1415 RIDGEBACK RD STE 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6983
Practice Address - Country:US
Practice Address - Phone:619-656-3775
Practice Address - Fax:858-549-3146
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical