Provider Demographics
NPI:1750572004
Name:FERNANDES-OSTERHOLD, GISELE (MA, MFT)
Entity type:Individual
Prefix:
First Name:GISELE
Middle Name:
Last Name:FERNANDES-OSTERHOLD
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1900
Mailing Address - Country:US
Mailing Address - Phone:510-595-5507
Mailing Address - Fax:510-597-1409
Practice Address - Street 1:3120 TELEGRAPH AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1900
Practice Address - Country:US
Practice Address - Phone:510-595-5507
Practice Address - Fax:510-507-1409
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01CROtherMEDI-CAL