Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ASW62302 | CA |
Y | 1041C0700X | Clinical Social Worker | LCSW80082 | CA |
NPI | 1003167230 |
---|---|
Provider Name | Charles Zachary Berman |
First Address | San Francisco, CA 94103-2911 |
Second Address | San Francisco, CA 94103-2911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2012 |
Last Update Date | 16/02/2018 |