Provider Demographics
NPI:1336570894
Name:BERALDO, JACQUELINE (FNP, MFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BERALDO
Suffix:
Gender:F
Credentials:FNP, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ALEGRIA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3730
Mailing Address - Country:US
Mailing Address - Phone:916-247-0660
Mailing Address - Fax:
Practice Address - Street 1:1010 ANACAPA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2103
Practice Address - Country:US
Practice Address - Phone:916-247-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36655106H00000X
CA332670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist