Healthcare Provider Details

I. General information

NPI: 1598323123
Provider Name (Legal Business Name): KIRANMAYI NEELARAMBAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 MARKET ST
KIRKLAND WA
98033-5441
US

IV. Provider business mailing address

1104 MARKET ST
KIRKLAND WA
98033-5441
US

V. Phone/Fax

Practice location:
  • Phone: 425-588-5914
  • Fax:
Mailing address:
  • Phone: 425-588-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number60940981
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number60940981
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number60940981
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number60940981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: