Healthcare Provider Details

I. General information

NPI: 1811394521
Provider Name (Legal Business Name): MAMTA DADLANI PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 WASHINGTON AVE
ALBANY CA
94706-1828
US

IV. Provider business mailing address

1435 WASHINGTON AVE
ALBANY CA
94706-1828
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-1971
  • Fax:
Mailing address:
  • Phone: 305-389-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MAMTA DADLANI
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 305-389-1971