MEDICARE: DUSHYANTHI SATCHI MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	002030	CT
2	1041C0700X	Clinical Social Worker	091490	NY
3	1041C0700X	Clinical Social Worker	58.010729	CT
4	1041C0700X	Clinical Social Worker	LCSW109162	CA

General Provider Information

NPI Number	:	1093200461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSHYANTHI SATCHI MS

Provider Business Mailing Address
First Line	:	1506 10TH ST APT 216
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2835
Country	:	US
Telephone Number	:	646-522-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 WILSHIRE BLVD
Second Line	:	SUITE 201
City	:	SANTA MONICA
State	:	CA
Zip	:	90403
Country	:	US
Telephone Number	:	310-765-1030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	09/22/2022

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