1639207897 NPI number — PROF. BERNADETTE YOUSIF TALIA LCSW 24868

Table of content: PROF. BERNADETTE YOUSIF TALIA LCSW 24868 (NPI 1639207897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639207897 NPI number — PROF. BERNADETTE YOUSIF TALIA LCSW 24868

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALIA
Provider First Name:
BERNADETTE
Provider Middle Name:
YOUSIF
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
LCSW 24868
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TALIA
Provider Other First Name:
BERNADETTE
Provider Other Middle Name:
YOUSIF
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.W
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639207897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92021-4899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-401-5500
Provider Business Mailing Address Fax Number:
610-401-5454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021-4899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-401-5500
Provider Business Practice Location Address Fax Number:
619-401-5454
Provider Enumeration Date:
03/01/2007

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: 1041C0700X , with the licence number:  LCS 24868 , 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)





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