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General NPI Number Information
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NPI Number | 1477316529
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Entity Type | Organization
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Legal Business Name | PCRT PALO ALTO PSYCHOTHERAPY FOR COMPLEX AND RELATIONAL TRAUMA
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 220 CALIFORNIA AVE STE 106
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City | PALO ALTO
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State | CA
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Zip | 94306-1627
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Country | US
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Telephone | 650-815-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 220 CALIFORNIA AVE STE 106
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City | PALO ALTO
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State | CA
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Zip | 94306-1627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA HARTMAN-NGALOAFE
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Credential | M.ED.; M.A.; LMFT
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Telephone | 650-815-9580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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