Provider Demographics
NPI:1043336043
Name:WEINSTEIN, KEITH MITCHELL (MFT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:MITCHELL
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2108
Mailing Address - Country:US
Mailing Address - Phone:510-222-3576
Mailing Address - Fax:510-526-1838
Practice Address - Street 1:902 CURTIS ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2108
Practice Address - Country:US
Practice Address - Phone:510-222-3576
Practice Address - Fax:510-526-1838
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA066580OtherMHN
CA463036OtherVALUE OPTIONS