MEDICARE: MARTHA BORJA ACACIO LMFT

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	101YM0800X	Mental Health Counselor	MFC 35556	CA

General Provider Information

NPI Number	:	1891848982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA BORJA ACACIO LMFT

Provider Business Mailing Address
First Line	:	768 ELM AVE
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-3403
Country	:	US
Telephone Number	:	650-589-1267
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 S VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1908
Country	:	US
Telephone Number	:	415-642-4507
Fax Number	:	415-695-6961

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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