Provider Demographics
NPI:1689930521
Name:BERENSTEIN, LAURA JEAN (MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:BERENSTEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:GAMBETTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:760 POLHEMUS RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3938
Mailing Address - Country:US
Mailing Address - Phone:650-349-8717
Mailing Address - Fax:650-349-0350
Practice Address - Street 1:760 POLHEMUS RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3938
Practice Address - Country:US
Practice Address - Phone:650-349-8717
Practice Address - Fax:650-349-0350
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist