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General NPI Number Information
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NPI Number | 1528514643
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Entity Type | Individual
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Provider Name | NISHA MARIA SATHIYANATHAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 283 N 300 W STE 501
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City | KAYSVILLE
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State | UT
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Zip | 84037-1881
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Country | US
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Telephone | 801-513-5694
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Fax | 801-719-6289
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Provider Business Mailing Address
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Address Line | 830 N 200 W
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6830
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Country | US
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Telephone | 801-589-8814
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Fax | 801-719-6289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10374942-3501
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License Number State | UT
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