Provider Demographics
NPI:1457372849
Name:FAERSTEIN, BERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:
Last Name:FAERSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MCALLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1633
Mailing Address - Country:US
Mailing Address - Phone:415-673-1290
Mailing Address - Fax:415-456-2466
Practice Address - Street 1:30 MCALLISTER AVE
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1633
Practice Address - Country:US
Practice Address - Phone:415-673-1290
Practice Address - Fax:415-456-2466
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5238103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR26168Medicare UPIN
CAPL52382Medicare ID - Type Unspecified