Provider Demographics
NPI:1548485360
Name:BERNAL, MARTA (ASW)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 VAN NESS AV
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-642-4553
Mailing Address - Fax:415-695-6963
Practice Address - Street 1:759 VAN NESS AV
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-642-4553
Practice Address - Fax:415-695-6963
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11002101YM0800X
CAASW63702104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
6530OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
6530OtherSFGH INTERNAL USE ONLY