| Doctor Name: | MS. AMY BERGHOLTZ |
| NPI Number: | 1124159454 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.S. |
| License Number: | |
| Business Practice Address: | 12450 Van Nuys Blvd Suite 200 Pacoima, CA - 913311391 |
| Business Phone Number: | 8188961161 |
| Business Fax Number: | 8188965069 |
| Mailing Address: | 257 1/2 Isabel St., LOS ANGELES |
| State: | CA |
| Postal Code: | 90065 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |