Provider Demographics
NPI:1912936063
Name:HAUG, NANCY ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:HAUG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:HAUG
Other - Last Name:PADUANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 JACKSON ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7141
Mailing Address - Country:US
Mailing Address - Phone:408-357-3527
Mailing Address - Fax:
Practice Address - Street 1:10 JACKSON ST STE 210B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7141
Practice Address - Country:US
Practice Address - Phone:408-357-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q21569Medicare UPIN
CA0PL196550Medicare ID - Type Unspecified