Healthcare Provider Details

I. General information

NPI: 1558737502
Provider Name (Legal Business Name): GAYATRI SUBRAMANIAM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FRONT ST STE 220
SANTA CRUZ CA
95060-4536
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 831-999-3524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: