Provider Demographics
NPI:1124232087
Name:HANNA, JAMIE LEE (MA MFT ATRBC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LEE
Last Name:HANNA
Suffix:
Gender:F
Credentials:MA MFT ATRBC
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 S AMPHLETT BLVD
Mailing Address - Street 2:# 118
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-655-2724
Mailing Address - Fax:650-655-2729
Practice Address - Street 1:1720 S AMPHLETT BLVD
Practice Address - Street 2:# 118
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-655-2724
Practice Address - Fax:650-655-2729
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist