Provider Demographics
NPI:1114417383
Name:SHU, BERNADETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:SHU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:SANTILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1023
Mailing Address - Country:US
Mailing Address - Phone:415-307-5763
Mailing Address - Fax:
Practice Address - Street 1:1303 SAN CARLOS AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2317
Practice Address - Country:US
Practice Address - Phone:650-434-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT128560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist