Doctor Name: | DR. REBECCA JEAN BERTRAM |
NPI Number: | 1467609669 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D., ATR |
License Number: | |
Business Practice Address: | 24863 W Jayne Ave Pleasnat Valley State Prison Coalinga, CA - 932109502 |
Business Phone Number: | 5599354900 |
Business Fax Number: | |
Mailing Address: | Po Box 8500, Pleasant Valley State Prison COALINGA |
State: | CA |
Postal Code: | 932108500 |
Phone Number: | 5599354900 |
Fax Number: | |
NPI Enumeration Date: | 08/19/2008 |
NPI Last Update Date: | 04/11/2016 |
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: |