Provider Demographics
NPI:1265791610
Name:MICHELLE SHARIAT-HANSEN
Entity type:Organization
Organization Name:MICHELLE SHARIAT-HANSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIAT-HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-497-7094
Mailing Address - Street 1:2 COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6123
Mailing Address - Country:US
Mailing Address - Phone:415-497-7094
Mailing Address - Fax:415-883-3014
Practice Address - Street 1:2 COMMERCIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6123
Practice Address - Country:US
Practice Address - Phone:415-497-7094
Practice Address - Fax:415-883-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty