Provider Demographics
NPI:1437263035
Name:BATHEJA, MADHU (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:MADHU
Middle Name:
Last Name:BATHEJA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 DIVISADERO ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2532
Mailing Address - Country:US
Mailing Address - Phone:415-441-4530
Mailing Address - Fax:
Practice Address - Street 1:1947 DIVISADERO ST
Practice Address - Street 2:SUITE NUMBER 5
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2532
Practice Address - Country:US
Practice Address - Phone:415-441-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist