Provider Demographics
NPI:1770890790
Name:BERARDINELLI, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BERARDINELLI
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 1:399 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7504
Mailing Address - Country:US
Mailing Address - Phone:831-643-9069
Mailing Address - Fax:
Practice Address - Street 1:320 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1808
Practice Address - Country:US
Practice Address - Phone:831-655-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA6880157OtherDRIVER LICENSE
CA27BW8OtherMEDI-CAL
CA41CDOOOtherMEDI-CAL
CA41BWOtherMEDI-CAL
CAPRVNBROtherMEDI-CAL