Provider Demographics
NPI:1972941342
Name:HACK, NICHOLAS DON (MA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DON
Last Name:HACK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PARK BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1114
Mailing Address - Country:US
Mailing Address - Phone:707-564-7579
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK BLVD
Practice Address - Street 2:STE 200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1114
Practice Address - Country:US
Practice Address - Phone:707-564-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical