Provider Demographics
NPI:1093487365
Name:MUKHERJEE, DHRUBODHI (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DHRUBODHI
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:DR
Other - First Name:DHRU
Other - Middle Name:
Other - Last Name:MUKHERJEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW-S
Mailing Address - Street 1:2416 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-2202
Mailing Address - Country:US
Mailing Address - Phone:618-303-1380
Mailing Address - Fax:
Practice Address - Street 1:2416 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-2202
Practice Address - Country:US
Practice Address - Phone:618-303-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106012101YM0800X
IL149.019534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health