Provider Demographics
NPI:1821298753
Name:BORILLO, CARMENCITA GISELLE BERSAMIN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CARMENCITA GISELLE
Middle Name:BERSAMIN
Last Name:BORILLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CARMENCITA GISELLE
Other - Middle Name:BERSAMIN
Other - Last Name:BRINGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1212 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1552
Mailing Address - Country:US
Mailing Address - Phone:209-468-8686
Mailing Address - Fax:209-468-2380
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-8686
Practice Address - Fax:209-468-2380
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51469101YM0800X, 101YP2500X
101Y00000X
CALMFT53691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53691OtherBOARD OF BEHAVIORAL SCIENCES
CA51469OtherBOARD OF BEHAVIORAL SCIEN