Healthcare Provider Details

I. General information

NPI: 1669284501
Provider Name (Legal Business Name): PREMI SUBRAMANIAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. PUVANASPRI SUBRAMANIAN

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 UHLAN CT
SANTA BARBARA CA
93103-2913
US

IV. Provider business mailing address

228 UHLAN CT
SANTA BARBARA CA
93103-2913
US

V. Phone/Fax

Practice location:
  • Phone: 805-679-1549
  • Fax:
Mailing address:
  • Phone: 805-679-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number123649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: