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General NPI Number Information
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NPI Number | 1366937476
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Entity Type | Individual
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Provider Name | MARTHA BADER LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/30/2018
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 15400 FOOTHILL BLVD BLDG C2F
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City | SAN LEANDRO
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State | CA
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Zip | 94578-1009
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Country | US
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Telephone | 510-895-4370
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Fax | 510-895-4583
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Provider Business Mailing Address
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Address Line | 484 LAKE PARK AVE # 541
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City | OAKLAND
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State | CA
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Zip | 94610-2730
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Country | US
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Telephone | 510-387-9487
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Fax |
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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 | 74278
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 94856
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License Number State | CA
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