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NPI Code Detail

MEDICARE: DR. JYOTHSNA SRIDHARAN BHAT PSYD

MEDICARE: DR. JYOTHSNA SRIDHARAN BHAT PSYD
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
1103TC0700XClinical PsychologistPS016723PA

General Provider Information

NPI Number : 1609105063
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JYOTHSNA SRIDHARAN BHAT PSYD
Provider Business Mailing Address
First Line : 35101 ELM CT
Second Line :
City : LAWRENCEVILLE
State : NJ
Zip : 08648-5209
Country : US
Telephone Number : 213-609-8732
Fax Number :
Provider Business Practice Location Address
First Line : 22 S STATE ST
Second Line : SUITE 3
City : NEWTOWN
State : PA
Zip : 18940-3507
Country : US
Telephone Number : 267-991-0108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2009
Last Update Date : 02/17/2015

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