Provider Demographics
NPI:1457239667
Name:THADANI, POONAM (MFT)
Entity type:Individual
Prefix:MS
First Name:POONAM
Middle Name:
Last Name:THADANI
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 1:1030 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3408
Mailing Address - Country:US
Mailing Address - Phone:650-630-9264
Mailing Address - Fax:
Practice Address - Street 1:1030 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3408
Practice Address - Country:US
Practice Address - Phone:650-630-9264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist