Provider Demographics
NPI:1588091631
Name:BERNSTEIN, PETER MARK (PHD, MFT, FAPA,)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARK
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:PHD, MFT, FAPA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5121
Mailing Address - Country:US
Mailing Address - Phone:707-762-3253
Mailing Address - Fax:707-762-8763
Practice Address - Street 1:501 2ND ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5121
Practice Address - Country:US
Practice Address - Phone:707-762-3253
Practice Address - Fax:707-762-8763
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 7549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist