Provider Demographics
NPI:1710003603
Name:AHERN, MICHAEL J (MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:AHERN
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 1:755 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1908
Mailing Address - Country:US
Mailing Address - Phone:415-642-4513
Mailing Address - Fax:415-695-6961
Practice Address - Street 1:755 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1908
Practice Address - Country:US
Practice Address - Phone:415-642-4513
Practice Address - Fax:415-695-6961
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7958OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
7958OtherSFGH INTERNAL USE ONLY