Provider Demographics
NPI:1528082377
Name:BERNDT, DOROTHY JEANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:JEANNE
Last Name:BERNDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 MOTOR AVE
Mailing Address - Street 2:SUITE #311
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6404
Mailing Address - Country:US
Mailing Address - Phone:310-374-7905
Mailing Address - Fax:310-374-7905
Practice Address - Street 1:3760 MOTOR AVE
Practice Address - Street 2:SUITE #311
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6404
Practice Address - Country:US
Practice Address - Phone:310-374-7905
Practice Address - Fax:310-374-7905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 46361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR38735Medicare ID - Type Unspecified
CAR38735Medicare UPIN