Provider Demographics
NPI:1750673620
Name:YAMAMOTO, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:YAMAMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1131 SAN FELIPE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2800
Mailing Address - Country:US
Mailing Address - Phone:831-636-4020
Mailing Address - Fax:831-636-4025
Practice Address - Street 1:1131 SAN FELIPE RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2800
Practice Address - Country:US
Practice Address - Phone:831-636-4020
Practice Address - Fax:831-636-4025
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical