Provider Demographics
NPI:1619582558
Name:BERMUDEZ, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:DIAZ VENEGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7601 CANBY AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2953
Mailing Address - Country:US
Mailing Address - Phone:818-921-3466
Mailing Address - Fax:
Practice Address - Street 1:7601 CANBY AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2953
Practice Address - Country:US
Practice Address - Phone:818-921-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100521101YM0800X, 104100000X
CALCSW1306891041C0700X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional