MEDICARE: SONICA THAKUR

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	101YM0800X	Mental Health Counselor	6600	CA
2	106H00000X	Marriage & Family Therapist	105823	CA

General Provider Information

NPI Number	:	1417321084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONICA THAKUR

Provider Business Mailing Address
First Line	:	3236 ROCKY WATER LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-4226
Country	:	US
Telephone Number	:	408-893-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 SAN ANTONIO RD STE 102
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4620
Country	:	US
Telephone Number	:	408-905-4918
Fax Number	:

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

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	09/16/2019

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Directions to “ SONICA THAKUR ” Practice Location

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