Provider Demographics
NPI:1831982024
Name:BLEEKER, JUSTINE COURTNEY (AMFT)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:COURTNEY
Last Name:BLEEKER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MS
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:ROSCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 ALAMEDA DE LAS PULGAS STE 235
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1185
Mailing Address - Country:US
Mailing Address - Phone:650-573-2541
Mailing Address - Fax:
Practice Address - Street 1:600 ELM ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3018
Practice Address - Country:US
Practice Address - Phone:650-802-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist