Provider Demographics
NPI:1285299354
Name:PRANATA, HERLINA (PHD)
Entity type:Individual
Prefix:
First Name:HERLINA
Middle Name:
Last Name:PRANATA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HERLINA
Other - Middle Name:
Other - Last Name:PRANATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1565 CHERRYLANE AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3521
Mailing Address - Country:US
Mailing Address - Phone:206-949-5489
Mailing Address - Fax:
Practice Address - Street 1:1565 CHERRYLANE AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3521
Practice Address - Country:US
Practice Address - Phone:206-949-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60530231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist