Provider Demographics
NPI:1457865081
Name:BORGIE, TODD JERALD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:JERALD
Last Name:BORGIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 37TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2105
Mailing Address - Country:US
Mailing Address - Phone:510-233-7555
Mailing Address - Fax:510-233-4545
Practice Address - Street 1:207 37TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2105
Practice Address - Country:US
Practice Address - Phone:510-233-7555
Practice Address - Fax:510-233-4545
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT119705106H00000X
CAIMF97571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist