Provider Demographics
NPI:1871680710
Name:BERNDES-CARLSON, TERESITA (MA)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:BERNDES-CARLSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TERESITA
Other - Middle Name:B
Other - Last Name:BERNDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE STE 708
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6842
Mailing Address - Country:US
Mailing Address - Phone:310-838-4403
Mailing Address - Fax:888-231-5872
Practice Address - Street 1:1460 7TH STREET
Practice Address - Street 2:# 201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401
Practice Address - Country:US
Practice Address - Phone:310-838-4403
Practice Address - Fax:310-395-4146
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist