Provider Demographics
NPI:1750519799
Name:NATHANSON, MARJORIE A (PH D)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:MRS
Other - First Name:MARJORIE
Other - Middle Name:N
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:921 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2311
Mailing Address - Country:US
Mailing Address - Phone:510-524-8075
Mailing Address - Fax:
Practice Address - Street 1:921 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2311
Practice Address - Country:US
Practice Address - Phone:510-524-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical