Healthcare Provider Details

I. General information

NPI: 1003167230
Provider Name (Legal Business Name): CHARLES ZACHARY BERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

IV. Provider business mailing address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8000
  • Fax: 415-597-8004
Mailing address:
  • Phone: 415-597-8079
  • Fax: 415-597-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW62302
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW80082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: