Provider Demographics
NPI:1942373949
Name:BERARDINO, STACEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:BERARDINO
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 1:26895 ALISO CREEK RD STE B # 627
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5302
Mailing Address - Country:US
Mailing Address - Phone:949-235-4874
Mailing Address - Fax:
Practice Address - Street 1:517 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4619
Practice Address - Country:US
Practice Address - Phone:714-568-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical