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General NPI Number Information
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NPI Number | 1265985873
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Entity Type | Individual
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Provider Name | LAURA ELIZABETH NATTA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2016
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Last Update Date | 07/31/2016
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Provider Practice Location Address
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Address Line | 125 BULKLEY AVE
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City | SAUSALITO
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State | CA
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Zip | 94965-2231
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Country | US
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Telephone | 415-339-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 CASA BONA AVE
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City | BELMONT
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State | CA
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Zip | 94002-1507
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Country | US
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Telephone | 417-849-3474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 27713
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 27713
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 27713
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License Number State | CA
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