Provider Demographics
NPI:1427135607
Name:GERSHBERG, DONALD MARC (MA MFT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MARC
Last Name:GERSHBERG
Suffix:
Gender:M
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 1:1539 W GARVEY AVE N
Mailing Address - Street 2:SCPMG
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2139
Mailing Address - Country:US
Mailing Address - Phone:626-856-3095
Mailing Address - Fax:626-856-3078
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:SUITE226
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:818-203-5531
Practice Address - Fax:323-478-0299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist