Healthcare Provider Details

I. General information

NPI: 1982836698
Provider Name (Legal Business Name): SEBASTIAN EVERETT BERRIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 CONCORD BLVD
CONCORD CA
94519-2608
US

IV. Provider business mailing address

2827 CONCORD BLVD
CONCORD CA
94519-2608
US

V. Phone/Fax

Practice location:
  • Phone: 925-322-0106
  • Fax:
Mailing address:
  • Phone: 925-322-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: