Provider Demographics
NPI:1558371658
Name:BERNSTEIN, ANNE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:C
Last Name:BERNSTEIN
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 1:2955 SHATTUCK AVENUE #12
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1808
Mailing Address - Country:US
Mailing Address - Phone:510-549-0598
Mailing Address - Fax:
Practice Address - Street 1:2955 SHATTUCK AVE # 12
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-549-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4290103TC0700X, 103TF0000X
CAMFC5940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFCC5940OtherMARR & FAM THERAPIST LIC
CAPSY4290OtherPSYCHOLOGIST LICENSE
00PL42900Medicare ID - Type Unspecified