Provider Demographics
NPI:1255497814
Name:BERKELEY THERAPY INSTITUTE
Entity Type:Organization
Organization Name:BERKELEY THERAPY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-841-8484
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000012103TC0700X, 106H00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ73365ZMedicare ID - Type Unspecified