Provider Demographics
NPI:1497782890
Name:CARTER, BERNIE (MFT)
Entity Type:Individual
Prefix:MR
First Name:BERNIE
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CAMINO ALTO
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2929
Mailing Address - Country:US
Mailing Address - Phone:415-485-5991
Mailing Address - Fax:650-355-8780
Practice Address - Street 1:45 CAMINO ALTO
Practice Address - Street 2:SUITE 208
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2929
Practice Address - Country:US
Practice Address - Phone:415-485-5991
Practice Address - Fax:650-355-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 11652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist