Provider Demographics
NPI:1639387400
Name:GERSTLER, DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:GERSTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 BANCROFT WAY
Mailing Address - Street 2:STE 307
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1405
Mailing Address - Country:US
Mailing Address - Phone:510-869-3790
Mailing Address - Fax:510-649-1133
Practice Address - Street 1:2041 BANCROFT WAY
Practice Address - Street 2:STE 307
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1405
Practice Address - Country:US
Practice Address - Phone:510-869-3790
Practice Address - Fax:510-649-1133
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18831OtherLCSW