Provider Demographics
NPI:1508521717
Name:GOTTSEGEN, HANNAH MILAN (MA)
Entity Type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:MILAN
Last Name:GOTTSEGEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CREST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1810
Mailing Address - Country:US
Mailing Address - Phone:415-509-8813
Mailing Address - Fax:
Practice Address - Street 1:405 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2317
Practice Address - Country:US
Practice Address - Phone:415-509-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT36781OtherBOARD OF BEHAVIORAL SCIENCES
CALMFT36781OtherPRIVATE PRACTICE