Provider Demographics
NPI:1386864213
Name:PLATT, GENEVIEVE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:K
Last Name:PLATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22112 CALL OF THE WILD RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-8809
Mailing Address - Country:US
Mailing Address - Phone:408-353-1167
Mailing Address - Fax:408-353-1842
Practice Address - Street 1:15810 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3315
Practice Address - Country:US
Practice Address - Phone:408-356-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15844103TC0700X
CARN360215363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL158440Medicare ID - Type Unspecified