Provider Demographics
NPI:1073040697
Name:JAGADISH, ULLASITHA (MS)
Entity Type:Individual
Prefix:
First Name:ULLASITHA
Middle Name:
Last Name:JAGADISH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STEARNS RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4608
Mailing Address - Country:US
Mailing Address - Phone:617-469-6410
Mailing Address - Fax:
Practice Address - Street 1:35 STEARNS RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4608
Practice Address - Country:US
Practice Address - Phone:617-469-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst