Provider Demographics
NPI:1285764233
Name:BERTOLINI, TAMARA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:BERTOLINI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19683 E GOLDEN BOUGH DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3813
Mailing Address - Country:US
Mailing Address - Phone:626-339-3600
Mailing Address - Fax:
Practice Address - Street 1:158 N GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3346
Practice Address - Country:US
Practice Address - Phone:626-914-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional