Healthcare Provider Details

I. General information

NPI: 1922386234
Provider Name (Legal Business Name): VASUDHA DEVANATHAN NARASIMHA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VASUDHA DEVANATHAN MSW

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EXECUTIVE PARK BLVD SUITE 4900
SAN FRANCISCO CA
94134-3394
US

IV. Provider business mailing address

250 EXECUTIVE PARK BLVD SUITE 4900
SAN FRANCISCO CA
94134-3394
US

V. Phone/Fax

Practice location:
  • Phone: 415-656-0116
  • Fax: 415-656-0117
Mailing address:
  • Phone: 415-656-0116
  • Fax: 415-656-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33346
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33346
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 69938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: