Provider Demographics
NPI:1578732046
Name:KIRSON, BURT (MFT)
Entity Type:Individual
Prefix:MR
First Name:BURT
Middle Name:
Last Name:KIRSON
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 1:760 HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107
Mailing Address - Country:US
Mailing Address - Phone:415-850-7414
Mailing Address - Fax:415-863-4867
Practice Address - Street 1:760 HARRISON STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1235
Practice Address - Country:US
Practice Address - Phone:415-850-7414
Practice Address - Fax:415-863-4867
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist