Provider Demographics
NPI:1720807068
Name:BASTARDO SUBERO, MARIA ANDREINA (LMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANDREINA
Last Name:BASTARDO SUBERO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BOUNTY DR APT 201
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2607
Mailing Address - Country:US
Mailing Address - Phone:415-684-0240
Mailing Address - Fax:
Practice Address - Street 1:318 S B ST STE 5
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4029
Practice Address - Country:US
Practice Address - Phone:650-239-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist