Provider Demographics
NPI:1205084027
Name:RAJAN, INDHUSHREE S (PHD)
Entity type:Individual
Prefix:MISS
First Name:INDHUSHREE
Middle Name:S
Last Name:RAJAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 MAPLEWOOD AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1583
Mailing Address - Country:US
Mailing Address - Phone:714-402-8101
Mailing Address - Fax:
Practice Address - Street 1:433 N CAMDEN DR FL 4
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4408
Practice Address - Country:US
Practice Address - Phone:424-285-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical