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General NPI Number Information
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NPI Number | 1265791610
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Entity Type | Organization
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Legal Business Name | MICHELLE SHARIAT-HANSEN
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 2 COMMERCIAL BLVD SUITE 200
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City | NOVATO
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State | CA
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Zip | 94949-6123
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Country | US
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Telephone | 415-497-7094
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Fax | 415-883-3014
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Provider Business Mailing Address
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Address Line | 2 COMMERCIAL BLVD SUITE 200
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City | NOVATO
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State | CA
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Zip | 94949-6123
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Country | US
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Telephone | 415-497-7094
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Fax | 415-883-3014
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MICHELLE SHARIAT-HANSEN
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Credential | PSYD
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Telephone | 415-497-7094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY19389
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License Number State | CA
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