Provider Demographics
NPI:1902421415
Name:GUSTMAN, BRIAN DANIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DANIEL
Last Name:GUSTMAN
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 1:399 LAUREL ST STE 9
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1952
Mailing Address - Country:US
Mailing Address - Phone:415-295-5537
Mailing Address - Fax:
Practice Address - Street 1:399 LAUREL ST STE 9
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1952
Practice Address - Country:US
Practice Address - Phone:720-593-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005139103T00000X
CAPSY33397103TB0200X, 103TC2200X
CACTC-200059350103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool