Provider Demographics
NPI:1528189131
Name:SERRANO, BONNIE JEAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN
Last Name:SERRANO
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 1:6355 TELEGRAPH AVE
Mailing Address - Street 2:#303
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1371
Mailing Address - Country:US
Mailing Address - Phone:510-594-4007
Mailing Address - Fax:510-595-0671
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:#303
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1371
Practice Address - Country:US
Practice Address - Phone:510-594-4007
Practice Address - Fax:510-595-0671
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist