Provider Demographics
NPI:1760020317
Name:GERSBERG, JUSTINE (BCBA, MA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:GERSBERG
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421146
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-1146
Mailing Address - Country:US
Mailing Address - Phone:619-369-5050
Mailing Address - Fax:877-485-5961
Practice Address - Street 1:9606 TIERRA GRANDE
Practice Address - Street 2:STE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:619-369-5050
Practice Address - Fax:877-485-5961
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-32495103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst