Healthcare Provider Details

I. General information

NPI: 1891848982
Provider Name (Legal Business Name): MARTHA BORJA ACACIO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

IV. Provider business mailing address

768 ELM AVE
SAN BRUNO CA
94066-3403
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-4507
  • Fax: 415-695-6961
Mailing address:
  • Phone: 650-589-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC 35556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: