Provider Demographics
NPI:1477316529
Name:PCRT PALO ALTO PSYCHOTHERAPY FOR COMPLEX AND RELATIONAL TRAUMA
Entity Type:Organization
Organization Name:PCRT PALO ALTO PSYCHOTHERAPY FOR COMPLEX AND RELATIONAL TRAUMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN-NGALOAFE
Authorized Official - Suffix:
Authorized Official - Credentials:MED; MA; LMFT
Authorized Official - Phone:650-815-9580
Mailing Address - Street 1:220 CALIFORNIA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 CALIFORNIA AVE STE 106
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1627
Practice Address - Country:US
Practice Address - Phone:650-815-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health