Provider Demographics
NPI:1528514643
Name:SATHIYANATHAN, NISHA MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:MARIA
Last Name:SATHIYANATHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 200 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6830
Mailing Address - Country:US
Mailing Address - Phone:801-589-8814
Mailing Address - Fax:801-719-6289
Practice Address - Street 1:283 N 300 W STE 501
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1881
Practice Address - Country:US
Practice Address - Phone:801-513-5694
Practice Address - Fax:801-719-6289
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10374942-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical