Basic Information
| Provider Information | |||||||||
| NPI: | 1396234431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHATTACHARJEE | ||||||||
| FirstName: | KASTURI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 LEE ST # 800223 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349245314 | ||||||||
| FaxNumber: | 4342434743 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 LEE ST # 800223 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349245314 | ||||||||
| FaxNumber: | 4342434743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103T00000X | 0810007105 | VA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.