Basic Information
Provider Information | |||||||||
NPI: | 1255470605 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARENBRUGGE | ||||||||
FirstName: | MARTHA | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CRABTREE | ||||||||
OtherFirstName: | MARTHA | ||||||||
OtherMiddleName: | ANNA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2001 THE ALAMEDA | ||||||||
Address2: | ALLIANCE FOR COMMUNITY CARE | ||||||||
City: | SAN JOSE | ||||||||
State: | CA | ||||||||
PostalCode: | 951261136 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4082617777 | ||||||||
FaxNumber: | 4082549960 | ||||||||
Practice Location | |||||||||
Address1: | 86 S 14TH ST | ||||||||
Address2: | ALLIANCE FOR COMMUNITY CARE ISP | ||||||||
City: | SAN JOSE | ||||||||
State: | CA | ||||||||
PostalCode: | 951122015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4089386750 | ||||||||
FaxNumber: | 4089770145 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/05/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LCSW 18869 | CA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | 6801014853 | MI | N |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.