Provider Demographics
NPI:1144330994
Name:BERTEAUX, CARMEN LOUISE (MA MFT)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LOUISE
Last Name:BERTEAUX
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 RIVER STREET SOUTH
Mailing Address - Street 2:STE 211
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-423-1433
Mailing Address - Fax:831-423-6194
Practice Address - Street 1:147 RIVER STREET SOUTH
Practice Address - Street 2:STE 211
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-423-1433
Practice Address - Fax:831-423-6194
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist