Provider Demographics
NPI:1063576403
Name:HANNIGAN, LINA MAY (PHD)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:MAY
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINA
Other - Middle Name:M
Other - Last Name:HANNIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6 EL CAPITAN CT
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6881
Mailing Address - Country:US
Mailing Address - Phone:510-814-6299
Mailing Address - Fax:
Practice Address - Street 1:4141 GEARY BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3109
Practice Address - Country:US
Practice Address - Phone:415-833-3327
Practice Address - Fax:415-833-4781
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20504103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service