Provider Demographics
NPI:1710024302
Name:QUACKENBUSH, NATASHA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:LYNN
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:LYNN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3454 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8238
Mailing Address - Country:US
Mailing Address - Phone:925-777-6359
Mailing Address - Fax:925-777-6363
Practice Address - Street 1:3454 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8238
Practice Address - Country:US
Practice Address - Phone:925-777-6359
Practice Address - Fax:925-777-6363
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18753103TC0700X
WATE00003764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical