Basic Information
| Provider Information | |||||||||
| NPI: | 1730502329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASUPULETI | ||||||||
| FirstName: | RADHIKA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 TREMONT AVE | ||||||||
| Address2: | VA NEW JERSEY HEALTHCARE SYSTEM, 11TH FLOOR, WRIISC | ||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070181023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3900 WOODLAND AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158235800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2014 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103TH0004X | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103T00000X | 021182 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.