Provider Demographics
NPI:1508082702
Name:EDWINA, NATASHA (MA, MS, LMFT)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:EDWINA
Suffix:
Gender:F
Credentials:MA, MS, LMFT
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:EDWINA
Other - Last Name:PANTTI-DULBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 CIVITA BLVD APT 332
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5154
Mailing Address - Country:US
Mailing Address - Phone:858-220-0934
Mailing Address - Fax:
Practice Address - Street 1:7901 CIVITA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5139
Practice Address - Country:US
Practice Address - Phone:858-220-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist