Provider Demographics
NPI:1376341925
Name:BERBERIAN, LAURIE (MS)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BERBERIAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 BARCLAY CT
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3201
Mailing Address - Country:US
Mailing Address - Phone:510-582-7478
Mailing Address - Fax:
Practice Address - Street 1:KENNEDY HIGH SCHOOL
Practice Address - Street 2:39999 BLACOW ROAD
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-9453
Practice Address - Country:US
Practice Address - Phone:510-657-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36756106H00000X
CA200066540103TS0200X
CA250028639101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool