MEDICARE: MAIYA CORRINE BERTRAND LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	136221	CA

General Provider Information

NPI Number	:	1326679770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIYA CORRINE BERTRAND LCSW

Provider Business Mailing Address
First Line	:	1950 SUNNY CREST DR STE 2600
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3644
Country	:	US
Telephone Number	:	714-446-5590
Fax Number	:	714-446-5592

Provider Business Practice Location Address
First Line	:	1950 SUNNY CREST DR STE 2600
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3644
Country	:	US
Telephone Number	:	714-446-5590
Fax Number	:	714-446-5592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	03/16/2026

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