Provider Demographics
NPI:1932767035
Name:BERTONE, AGUSTINA (PHD)
Entity type:Individual
Prefix:DR
First Name:AGUSTINA
Middle Name:
Last Name:BERTONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 STATE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7071
Mailing Address - Country:US
Mailing Address - Phone:805-263-7083
Mailing Address - Fax:
Practice Address - Street 1:629 STATE ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7071
Practice Address - Country:US
Practice Address - Phone:805-263-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA33192103TC0700X
CAPSY33192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist