Individual provider Active NPI

Bruce Miles Chernack, MARRIAGE, FAMILY THE

  • Marriage & Family Therapist
  • Mill Valley, CA
National Provider Identifier
1912148743
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT#27085 Issued in CA
Practice address
205 Camino Alto
Suite 160
Mill Valley, CA 94941
Phone
(415) 389-6747
Fax
(415) 380-0345
NPI assigned
Mar 6, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT#27085 CA Primary

Addresses

Primary practice location

205 Camino Alto
Suite 160
Mill Valley, CA 94941

Mailing address

205 Camino Alto
Suite 160
Mill Valley, CA 94941
Phone (415) 389-6747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MFT#27085CAMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236297600000",
    "number": "1912148743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 CAMINO ALTO",
            "address_2": "SUITE 160",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-389-6747",
            "fax_number": "415-380-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 CAMINO ALTO",
            "address_2": "SUITE 160",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-389-6747",
            "fax_number": "415-380-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHERNACK",
        "first_name": "BRUCE",
        "middle_name": "MILES",
        "name_prefix": "Mr.",
        "credential": "MARRIAGE, FAMILY THE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFT#27085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.