Provider Demographics
NPI:1013093459
Name:HASSAN, MARK DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:HASSAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 W HUNTINGTON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1222
Mailing Address - Country:US
Mailing Address - Phone:626-458-5444
Mailing Address - Fax:626-458-0679
Practice Address - Street 1:1961 W HUNTINGTON DR STE 202
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1222
Practice Address - Country:US
Practice Address - Phone:626-458-5444
Practice Address - Fax:626-458-0679
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5298103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis