Provider Demographics
NPI:1194882738
Name:BURNSTEIN, VICTOR JOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JOEL
Last Name:BURNSTEIN
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 1:1621 114TH AVE SE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-455-5919
Mailing Address - Fax:425-688-9987
Practice Address - Street 1:1621 114TH AVE SE
Practice Address - Street 2:SUITE 221
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-455-5919
Practice Address - Fax:425-688-9987
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002042103TC0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB15899Medicare ID - Type Unspecified