Basic Information
| Provider Information | |||||||||
| NPI: | 1982727095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERSUDSKY | ||||||||
| FirstName: | SHANA | ||||||||
| MiddleName: | ELYSE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5465 NEWCASTLE AVE | ||||||||
| Address2: | # 2 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913162077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183454823 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2055 LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911031324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267986793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 52660 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.