Provider Demographics
NPI:1013205822
Name:NEGOME-KAPUR, NANAKO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANAKO
Middle Name:
Last Name:NEGOME-KAPUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:NANAKO
Other - Middle Name:
Other - Last Name:NEGOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4583
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-819-6115
Practice Address - Street 1:17218 N 72ND DR STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-334-8671
Practice Address - Fax:623-334-8675
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1718103T00000X
AZPSY-005188103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist