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General NPI Number Information
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NPI Number | 1285757740
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Entity Type | Individual
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Provider Name | BERNARD MICHAEL BERLIN LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2260 FLOYD AVE # 100
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City | MODESTO
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State | CA
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Zip | 95355-9602
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Country | US
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Telephone | 209-527-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 LOS GAMOS DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1806
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Country | US
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Telephone | 415-455-0676
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Fax | 415-472-8183
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS10041
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License Number State | CA
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