MEDICARE: DR. AGUSTINA BERTONE PHD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	33192	CA
3	103T00000X	Psychologist	PSY33192	CA

General Provider Information

NPI Number	:	1932767035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGUSTINA BERTONE PHD

Provider Business Mailing Address
First Line	:	629 STATE ST STE 202
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-7071
Country	:	US
Telephone Number	:	805-263-7083
Fax Number	:

Provider Business Practice Location Address
First Line	:	629 STATE ST STE 202
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-7071
Country	:	US
Telephone Number	:	805-263-7083
Fax Number	:

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	11/12/2024

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