Provider Demographics
NPI:1629051271
Name:CASE, NANCY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:C
Last Name:CASE
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 1:50 SEACAPE DR
Mailing Address - Street 2:
Mailing Address - City:MUIR BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94965-9737
Mailing Address - Country:US
Mailing Address - Phone:415-389-5474
Mailing Address - Fax:415-389-8719
Practice Address - Street 1:10 WILLOW ST
Practice Address - Street 2:#1
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2845
Practice Address - Country:US
Practice Address - Phone:415-454-4326
Practice Address - Fax:415-389-8719
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL62240Medicare ID - Type Unspecified