Healthcare Provider Details

I. General information

NPI: 1457372849
Provider Name (Legal Business Name): BERT FAERSTEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MCALLISTER AVE
KENTFIELD CA
94904-1633
US

IV. Provider business mailing address

30 MCALLISTER AVE
KENTFIELD CA
94904-1633
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-1290
  • Fax: 415-456-2466
Mailing address:
  • Phone: 415-673-1290
  • Fax: 415-456-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY5238
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: