Provider Demographics
NPI:1013154418
Name:BLACK, MURVA (MFT)
Entity Type:Individual
Prefix:
First Name:MURVA
Middle Name:
Last Name:BLACK
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 1:20551 SUMMERGLEN PL
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5343
Mailing Address - Country:US
Mailing Address - Phone:510-581-1445
Mailing Address - Fax:
Practice Address - Street 1:20551 SUMMERGLEN PL
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5343
Practice Address - Country:US
Practice Address - Phone:510-581-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist