Provider Demographics
NPI:1528277159
Name:BERMUDES, ESTELLE (BA IN PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:BERMUDES
Suffix:
Gender:F
Credentials:BA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3937
Mailing Address - Country:US
Mailing Address - Phone:310-696-8190
Mailing Address - Fax:
Practice Address - Street 1:161 W VICTORIA ST STE 255
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2178
Practice Address - Country:US
Practice Address - Phone:310-603-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health