MEDICARE: JASON HATAKEYAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	ASW 30811	CA
2	1041C0700X	Clinical Social Worker	LCSW84528	CA

General Provider Information

NPI Number	:	1770669244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON HATAKEYAMA

Provider Business Mailing Address
First Line	:	532 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2044
Country	:	US
Telephone Number	:	626-229-3869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	12/16/2020

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Directions to “ JASON HATAKEYAMA ” Practice Location

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