Basic Information
| Provider Information | |||||||||
| NPI: | 1912101775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DASGUPTA | ||||||||
| FirstName: | GARGI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19231 VICTORY BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913356308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187084500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19231 VICTORY BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913356308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187084500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | PSY 21406 | CA | X | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | PSY 21406 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | PSY 21406 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | PSY 21406 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Family | 103TM1800X | PSY 21406 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
No ID Information.