Healthcare Provider Details

I. General information

NPI: 1013337161
Provider Name (Legal Business Name): THE BERNSTEIN INSTITUTE FOR TRAUMA TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 2ND ST
PETALUMA CA
94952-5121
US

IV. Provider business mailing address

501 2ND ST
PETALUMA CA
94952-5121
US

V. Phone/Fax

Practice location:
  • Phone: 707-781-3335
  • Fax: 707-762-8763
Mailing address:
  • Phone: 707-781-3335
  • Fax: 707-762-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMFT7549
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number633153
License Number StateCA

VIII. Authorized Official

Name: DR. PETER MARK BERNSTEIN
Title or Position: PRESIDENT
Credential: PHD
Phone: 707-781-3335