Provider Demographics
NPI:1366937476
Name:BADER, MARTHA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 LAKE PARK AVE # 541
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2730
Mailing Address - Country:US
Mailing Address - Phone:510-387-9487
Mailing Address - Fax:
Practice Address - Street 1:15400 FOOTHILL BLVD BLDG C2F
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1009
Practice Address - Country:US
Practice Address - Phone:510-895-4370
Practice Address - Fax:510-895-4583
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA742781041C0700X
CA948561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94856OtherBOARD OF BEHAVIORAL SCIENCES
NCC013153OtherNC SOCIAL WORK AND CERTIFICATION BOARD