Provider Demographics
NPI:1285757740
Name:BERLIN, BERNARD MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:MICHAEL
Last Name:BERLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LOS GAMOS DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1806
Mailing Address - Country:US
Mailing Address - Phone:415-455-0676
Mailing Address - Fax:415-472-8183
Practice Address - Street 1:2260 FLOYD AVE # 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9602
Practice Address - Country:US
Practice Address - Phone:209-527-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS100411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical