Provider Demographics
NPI:1205293073
Name:RAMAKRISHNAN, TERESA D (MFT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:RAMAKRISHNAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 QUAIL CT
Mailing Address - Street 2:STE. 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8791
Mailing Address - Country:US
Mailing Address - Phone:925-979-5503
Mailing Address - Fax:
Practice Address - Street 1:38 QUAIL CT
Practice Address - Street 2:STE. 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8791
Practice Address - Country:US
Practice Address - Phone:925-979-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 88604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist