Healthcare Provider Details

I. General information

NPI: 1710045612
Provider Name (Legal Business Name): H. NICOLE HESS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 VIA DEL ORO
SAN JOSE CA
95119-1451
US

IV. Provider business mailing address

831 MARSH RD
MENLO PARK CA
94025-2051
US

V. Phone/Fax

Practice location:
  • Phone: 408-360-2350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 22960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: