Provider Demographics
NPI:1053401455
Name:NOVAKOVIC-AGOPIAN, TATJANA (PHD)
Entity type:Individual
Prefix:DR
First Name:TATJANA
Middle Name:
Last Name:NOVAKOVIC-AGOPIAN
Suffix:
Gender:F
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:PO BOX 225307
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-5307
Mailing Address - Country:US
Mailing Address - Phone:415-753-3888
Mailing Address - Fax:415-333-2707
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:SUITE 104A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3441
Practice Address - Country:US
Practice Address - Phone:415-753-3888
Practice Address - Fax:415-333-2707
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14601103G00000X, 103TC0700X
103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 14601OtherLICENSE
CAPSY 14601OtherLICENSE