Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY22136 | CA |
N | 103T00000X | Psychologist | PSY22136 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY22136 | CA |
Y | 103G00000X | Clinical Psychologist | PSY22136 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY22136 | CA |
NPI | 1568611085 |
---|---|
Provider Name | Dr. William John Hanna |
First Address | San Rafael, CA 94903-4271 |
Second Address | San Rafael, CA 94903-4271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2008 |
Last Update Date | 09/09/2008 |