Provider Demographics
NPI:1386843688
Name:HENDLIN, RUSSELL ERIC (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ERIC
Last Name:HENDLIN
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SAN GERONIMO
Mailing Address - State:CA
Mailing Address - Zip Code:94963-0189
Mailing Address - Country:US
Mailing Address - Phone:415-233-0788
Mailing Address - Fax:
Practice Address - Street 1:3075 ADELINE ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703
Practice Address - Country:US
Practice Address - Phone:510-848-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01CROtherMEDICAL