Provider Demographics
NPI:1720898877
Name:BERENSOHN, CRISTINE JOANN (MG61629412)
Entity type:Individual
Prefix:
First Name:CRISTINE
Middle Name:JOANN
Last Name:BERENSOHN
Suffix:
Gender:F
Credentials:MG61629412
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 SE OVERAA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8684
Mailing Address - Country:US
Mailing Address - Phone:206-940-9209
Mailing Address - Fax:
Practice Address - Street 1:2497 BETHEL RD SE STE 201
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2489
Practice Address - Country:US
Practice Address - Phone:360-919-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61629412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist