Provider Demographics
NPI:1306198676
Name:GUERTIN, MARGARET ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANN
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2112
Mailing Address - Country:US
Mailing Address - Phone:510-525-2040
Mailing Address - Fax:
Practice Address - Street 1:910 TULARE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94707-2112
Practice Address - Country:US
Practice Address - Phone:510-525-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical