Provider Demographics
NPI:1053478248
Name:FOSTER, THERESE BERNADETTE (BA)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:BERNADETTE
Last Name:FOSTER
Suffix:
Gender:
Credentials:BA
Other - Prefix:MS
Other - First Name:TERRY
Other - Middle Name:BERNADETTE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:65 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-259-7811
Mailing Address - Fax:
Practice Address - Street 1:65 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-455-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health