Michael Edelstein
Individual provider Active NPI Psychologist · Tiburon, CA
NPI 1124701917 · NPPES record last updated Aug 9, 2023
Key facts
- NPI
- 1124701917
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY12307 (CA)
- Practice address
- 35 Barbaree Way
Tiburon, CA 94920-2234 - Phone
- (415) 673-2848
- NPI assigned
- Aug 9, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY12307 | CA | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY12307 | CA | Yes |
Addresses
Primary practice location
35 Barbaree Way
Tiburon, CA 94920-2234
Mailing address
35 Barbaree Way
Tiburon, CA 94920-2234
Other providers in Tiburon, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.