Healthcare Provider Details

I. General information

NPI: 1114882495
Provider Name (Legal Business Name): SUMANA MITTA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 THE ALAMEDA STE 201
SAN JOSE CA
95126-1149
US

IV. Provider business mailing address

215 COLIBRI CT
SAN JOSE CA
95119-1711
US

V. Phone/Fax

Practice location:
  • Phone: 510-363-5760
  • Fax:
Mailing address:
  • Phone: 510-363-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT149986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: