MEDICARE: MS. NIYANTA ACHARYA AMFT

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	106H00000X	Marriage & Family Therapist	AMFT149601	CA

General Provider Information

NPI Number	:	1841019072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIYANTA ACHARYA AMFT

Provider Business Mailing Address
First Line	:	10935 PEACH GROVE ST APT 3
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-4657
Country	:	US
Telephone Number	:	818-301-4369
Fax Number	:

Provider Business Practice Location Address
First Line	:	10935 PEACH GROVE ST APT 3
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-4657
Country	:	US
Telephone Number	:	818-301-4369
Fax Number	:

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

Provider Enumeration Date	:	10/04/2024
Last Update Date	:	10/04/2024

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