Healthcare Provider Details

I. General information

NPI: 1336025444
Provider Name (Legal Business Name): NADEEM STEWART HASAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1024
CAMPBELL CA
95009-1024
US

IV. Provider business mailing address

PO BOX 1024
CAMPBELL CA
95009-1024
US

V. Phone/Fax

Practice location:
  • Phone: 650-209-7402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: