Provider Demographics
NPI:1558484964
Name:DE VERA, MAGNOLIA BOND (MFT)
Entity Type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:BOND
Last Name:DE VERA
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:PO BOX 881314
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94188-1314
Mailing Address - Country:US
Mailing Address - Phone:415-933-7117
Mailing Address - Fax:415-643-7118
Practice Address - Street 1:2675 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3325
Practice Address - Country:US
Practice Address - Phone:415-933-7117
Practice Address - Fax:415-643-7118
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist