Provider Demographics
NPI:1669511788
Name:KERSHENSTINE, TIMOTHY
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KERSHENSTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ASHBURY ST
Mailing Address - Street 2:APT. #6
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2977
Mailing Address - Country:US
Mailing Address - Phone:415-558-1724
Mailing Address - Fax:
Practice Address - Street 1:248 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3074
Practice Address - Country:US
Practice Address - Phone:650-363-4435
Practice Address - Fax:650-361-1620
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor