Provider Demographics
NPI:1548043235
Name:CONTRERAS, BERNADETTE (R1477890822)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:R1477890822
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2501
Mailing Address - Country:US
Mailing Address - Phone:530-320-2911
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD ST STE 111
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2501
Practice Address - Country:US
Practice Address - Phone:530-320-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1477890822101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker