Healthcare Provider Details

I. General information

NPI: 1932767035
Provider Name (Legal Business Name): AGUSTINA BERTONE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 STATE ST STE 202
SANTA BARBARA CA
93101-7071
US

IV. Provider business mailing address

629 STATE ST STE 202
SANTA BARBARA CA
93101-7071
US

V. Phone/Fax

Practice location:
  • Phone: 805-263-7083
  • Fax:
Mailing address:
  • Phone: 805-263-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33192
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY33192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: