Provider Demographics
NPI:1295169530
Name:HERNSDORF, DALE (LMFT)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:
Last Name:HERNSDORF
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 1:3231 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3221
Mailing Address - Country:US
Mailing Address - Phone:310-230-2728
Mailing Address - Fax:
Practice Address - Street 1:3231 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3221
Practice Address - Country:US
Practice Address - Phone:310-230-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist