Provider Demographics
NPI:1639207897
Name:TALIA, BERNADETTE YOUSIF (LCSW 24868)
Entity Type:Individual
Prefix:PROF
First Name:BERNADETTE
Middle Name:YOUSIF
Last Name:TALIA
Suffix:
Gender:F
Credentials:LCSW 24868
Other - Prefix:PROF
Other - First Name:BERNADETTE
Other - Middle Name:YOUSIF
Other - Last Name:TALIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1000 BROADWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4899
Mailing Address - Country:US
Mailing Address - Phone:619-401-5500
Mailing Address - Fax:610-401-5454
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4899
Practice Address - Country:US
Practice Address - Phone:619-401-5500
Practice Address - Fax:619-401-5454
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 248681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical