Provider Demographics
NPI:1720288103
Name:BERLIN, ANN MARIE LEBERT (MFT)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:LEBERT
Last Name:BERLIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2206
Mailing Address - Country:US
Mailing Address - Phone:510-654-6342
Mailing Address - Fax:510-654-6342
Practice Address - Street 1:5920 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2206
Practice Address - Country:US
Practice Address - Phone:510-654-6342
Practice Address - Fax:510-654-6342
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherHEALTHCARE PROVIDER