Provider Demographics
NPI:1740510643
Name:GERSTEIN, OFFRA GIELAN (PHD)
Entity type:Individual
Prefix:
First Name:OFFRA
Middle Name:GIELAN
Last Name:GERSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1827
Mailing Address - Country:US
Mailing Address - Phone:831-476-7666
Mailing Address - Fax:831-479-7005
Practice Address - Street 1:3333 MISSION DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-476-7666
Practice Address - Fax:831-479-7005
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY4707OtherBOARD OF PSYCHOLOGY