Provider Demographics
NPI:1033272844
Name:BISNO, MARGARETTA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARETTA
Middle Name:H
Last Name:BISNO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 HAROLD WAY STE CW506
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1425
Mailing Address - Country:US
Mailing Address - Phone:510-883-0619
Mailing Address - Fax:866-292-1925
Practice Address - Street 1:2222 HAROLD WAY STE CW506
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1425
Practice Address - Country:US
Practice Address - Phone:510-883-0619
Practice Address - Fax:866-292-1925
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171091Medicare ID - Type Unspecified