Provider Demographics
NPI:1912148743
Name:CHERNACK, BRUCE MILES (MARRIAGE, FAMILY THE)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:MILES
Last Name:CHERNACK
Suffix:
Gender:M
Credentials:MARRIAGE, FAMILY THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CAMINO ALTO
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-389-6747
Mailing Address - Fax:415-380-0345
Practice Address - Street 1:205 CAMINO ALTO
Practice Address - Street 2:SUITE 160
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-389-6747
Practice Address - Fax:415-380-0345
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#27085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist