Healthcare Provider Details

I. General information

NPI: 1558317297
Provider Name (Legal Business Name): JEANETTE HSU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE PSYCHOLOGY SERVICE (116B)
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE PSYCHOLOGY SERVICE (116B)
PALO ALTO CA
94304-1207
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-852-3445
Mailing address:
  • Phone: 650-493-5000
  • Fax: 650-852-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: