Provider Demographics
NPI:1699960666
Name:POTREBIC, GORDANA (PSYD)
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:POTREBIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PLEASANT HILL AVE N
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3164
Mailing Address - Country:US
Mailing Address - Phone:707-478-5689
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT HILL AVE N
Practice Address - Street 2:SUITE 340
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3164
Practice Address - Country:US
Practice Address - Phone:707-478-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27343103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist