Provider Demographics
NPI:1043340599
Name:HASSAN, GINA (PHD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:WALLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 SHATTUCK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1601
Mailing Address - Country:US
Mailing Address - Phone:510-644-1097
Mailing Address - Fax:
Practice Address - Street 1:1600 SHATTUCK AVE STE 200
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1601
Practice Address - Country:US
Practice Address - Phone:510-644-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist