1922449131 NPI number — MS. BRIDGET HOPE BERTRAND LMFT 83020

Table of content: MS. BRIDGET HOPE BERTRAND LMFT 83020 (NPI 1922449131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922449131 NPI number — MS. BRIDGET HOPE BERTRAND LMFT 83020

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERTRAND
Provider First Name:
BRIDGET
Provider Middle Name:
HOPE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT 83020
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922449131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 W 25TH AVE STE 1
Provider Second Line Business Mailing Address:
210
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94403-2264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-539-4325
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 W 25TH AVE STE 1
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94403-2264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-539-4325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  83020 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com