Provider Demographics
NPI:1376715417
Name:BERMUDEZ, MARGARITA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 COLLEGE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3400
Mailing Address - Country:US
Mailing Address - Phone:707-372-9719
Mailing Address - Fax:530-772-8441
Practice Address - Street 1:1652 W TEXAS ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5952
Practice Address - Country:US
Practice Address - Phone:707-372-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical