Provider Demographics
NPI:1275672602
Name:BORG, CARMELINA (MFT)
Entity Type:Individual
Prefix:MS
First Name:CARMELINA
Middle Name:
Last Name:BORG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 RALSTON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2249
Mailing Address - Country:US
Mailing Address - Phone:650-591-5852
Mailing Address - Fax:650-634-0810
Practice Address - Street 1:974 RALSTON AVE STE 6
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2249
Practice Address - Country:US
Practice Address - Phone:650-591-5852
Practice Address - Fax:650-634-0810
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80518Medicaid