MEDICARE: MS. DIANE GERSTLER LCSW

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	1041C0700X	Clinical Social Worker	18831	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18831	OTHER	CA	LCSW

General Provider Information

NPI Number	:	1639387400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE GERSTLER LCSW

Provider Business Mailing Address
First Line	:	2041 BANCROFT WAY
Second Line	:	STE 307
City	:	BERKELEY
State	:	CA
Zip	:	94704-1405
Country	:	US
Telephone Number	:	510-869-3790
Fax Number	:	510-649-1133

Provider Business Practice Location Address
First Line	:	2041 BANCROFT WAY
Second Line	:	STE 307
City	:	BERKELEY
State	:	CA
Zip	:	94704-1405
Country	:	US
Telephone Number	:	510-869-3790
Fax Number	:	510-649-1133

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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