Provider Demographics
NPI:1033275664
Name:GOLDSTINE, DANIEL BENNO (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BENNO
Last Name:GOLDSTINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2139
Mailing Address - Country:US
Mailing Address - Phone:510-841-8484
Mailing Address - Fax:510-540-1707
Practice Address - Street 1:1749 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2139
Practice Address - Country:US
Practice Address - Phone:510-841-8484
Practice Address - Fax:510-540-1707
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL394801Medicare PIN