Provider Demographics
NPI:1003502964
Name:DHANARAJ, CHERUBA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERUBA
Middle Name:A
Last Name:DHANARAJ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHERUBA
Other - Middle Name:C
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 FARRELL AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5523
Mailing Address - Country:US
Mailing Address - Phone:616-635-0677
Mailing Address - Fax:
Practice Address - Street 1:905 FARRELL AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5523
Practice Address - Country:US
Practice Address - Phone:616-635-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional