Basic Information
Provider Information
NPI: 1376715029
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHERBINSKI
FirstName: MICHAEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber: 8054682000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/01/2008
LastUpdateDate: 08/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X20042235AINN Behavioral Health & Social Service ProvidersPsychologistClinical
103TC0700X29847CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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