Provider Demographics
NPI:1336727759
Name:BERNARD, KEY
Entity type:Individual
Prefix:
First Name:KEY
Middle Name:
Last Name:BERNARD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:MARQUITA
Other - Middle Name:LYNETTE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1390 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5404
Mailing Address - Country:US
Mailing Address - Phone:415-936-3831
Mailing Address - Fax:
Practice Address - Street 1:2275 MARKET ST STE E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1652
Practice Address - Country:US
Practice Address - Phone:415-936-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123488104100000X, 101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor