1255531034 NPI number — MAUREEN THERESA GATT PH.D.

Table of content: MAUREEN THERESA GATT PH.D. (NPI 1255531034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255531034 NPI number — MAUREEN THERESA GATT PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATT
Provider First Name:
MAUREEN
Provider Middle Name:
THERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255531034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21969
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95151-1969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-494-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39350 CIVIC CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-494-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY60411233 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY 25735 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY 25735 . This is a "BOARD OF PSYCHOLOGY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PY60411233 . This is a "DEPARTMENT OF HEALTH, BOARD OF PSYCHOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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