Provider Demographics
NPI:1972495919
Name:MUDBHARY, BLUE
Entity type:Individual
Prefix:
First Name:BLUE
Middle Name:
Last Name:MUDBHARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W PORTAL AVE # 49
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1423
Mailing Address - Country:US
Mailing Address - Phone:415-418-4286
Mailing Address - Fax:
Practice Address - Street 1:236 W PORTAL AVE # 49
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1423
Practice Address - Country:US
Practice Address - Phone:415-418-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist