Provider Demographics
NPI:1508171992
Name:HANSSEN, TORA (MD)
Entity Type:Individual
Prefix:DR
First Name:TORA
Middle Name:
Last Name:HANSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 THE ALAMEDA
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2311
Mailing Address - Country:US
Mailing Address - Phone:510-525-3755
Mailing Address - Fax:510-525-3010
Practice Address - Street 1:921 THE ALAMEDA
Practice Address - Street 2:SUITE 222
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2311
Practice Address - Country:US
Practice Address - Phone:510-525-3755
Practice Address - Fax:510-525-3010
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42856102L00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst