Basic Information
| Provider Information | |||||||||
| NPI: | 1922386234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NARASIMHA | ||||||||
| FirstName: | VASUDHA | ||||||||
| MiddleName: | DEVANATHAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ACSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEVANATHAN | ||||||||
| OtherFirstName: | VASUDHA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 250 EXECUTIVE PARK BLVD | ||||||||
| Address2: | SUITE 4900 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941343394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156560116 | ||||||||
| FaxNumber: | 4156560117 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 EXECUTIVE PARK BLVD | ||||||||
| Address2: | SUITE 4900 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941343394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156560116 | ||||||||
| FaxNumber: | 4156560117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2011 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | 33346 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 33346 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW 69938 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.