Provider Demographics
NPI:1013337161
Name:THE BERNSTEIN INSTITUTE FOR TRAUMA TREATMENT
Entity type:Organization
Organization Name:THE BERNSTEIN INSTITUTE FOR TRAUMA TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-781-3335
Mailing Address - Street 1:501 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5121
Mailing Address - Country:US
Mailing Address - Phone:707-781-3335
Mailing Address - Fax:707-762-8763
Practice Address - Street 1:501 2ND ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5121
Practice Address - Country:US
Practice Address - Phone:707-781-3335
Practice Address - Fax:707-762-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633153261QP2000X
CAMFT7549261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy