MEDICARE: DR. LOUISE L BERTMAN P.H.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY17223	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00001382	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1831116672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISE L BERTMAN P.H.D.

Provider Business Mailing Address
First Line	:	490 POST ST STE 1554
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1306
Country	:	US
Telephone Number	:	415-788-1554
Fax Number	:	415-788-1559

Provider Business Practice Location Address
First Line	:	490 POST ST STE 1554
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1306
Country	:	US
Telephone Number	:	415-788-1554
Fax Number	:	415-788-1559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/24/2009

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