Provider Demographics
NPI:1407983554
Name:BLACKMAN, BONNIE (PHD MFT)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:MS
Other - First Name:BONITA
Other - Middle Name:
Other - Last Name:GERLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3142 BALI LN
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6905
Mailing Address - Country:US
Mailing Address - Phone:510-381-2791
Mailing Address - Fax:
Practice Address - Street 1:3142 BALI LN
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6905
Practice Address - Country:US
Practice Address - Phone:510-381-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist