Provider Demographics
NPI:1861797524
Name:TRIVEDI, SUSHMA SHRIKANT (MA)
Entity type:Individual
Prefix:MS
First Name:SUSHMA
Middle Name:SHRIKANT
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2554
Mailing Address - Country:US
Mailing Address - Phone:408-206-9066
Mailing Address - Fax:650-323-2212
Practice Address - Street 1:2875 MIDDLEFIELD RD
Practice Address - Street 2:SUITE 8
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2554
Practice Address - Country:US
Practice Address - Phone:408-206-9066
Practice Address - Fax:650-323-2212
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist