Provider Demographics
NPI:1982269122
Name:BERUMEN, DENISE ANGELICA
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANGELICA
Last Name:BERUMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HENDERSON PL
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1337
Mailing Address - Country:US
Mailing Address - Phone:650-739-5736
Mailing Address - Fax:
Practice Address - Street 1:200 CHANNING AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2720
Practice Address - Country:US
Practice Address - Phone:650-688-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134101106H00000X
CA95317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist