Provider Demographics
NPI:1356962310
Name:BENDER, DONALD IRA (MFCT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:IRA
Last Name:BENDER
Suffix:
Gender:M
Credentials:MFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1603
Mailing Address - Country:US
Mailing Address - Phone:510-697-5675
Mailing Address - Fax:
Practice Address - Street 1:1164 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1603
Practice Address - Country:US
Practice Address - Phone:510-697-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM16741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty