Provider Demographics
NPI:1255670311
Name:HATTORI, NOBUKO (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOBUKO
Middle Name:
Last Name:HATTORI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NONI
Other - Middle Name:
Other - Last Name:HATTORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:139 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-7505
Mailing Address - Country:US
Mailing Address - Phone:707-364-0226
Mailing Address - Fax:
Practice Address - Street 1:7428 REDWOOD BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2419
Practice Address - Country:US
Practice Address - Phone:707-364-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical