Provider Demographics
NPI:1114299039
Name:JAKATDAR, TEJAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:TEJAL
Middle Name:
Last Name:JAKATDAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 S BASCOM AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3545
Mailing Address - Country:US
Mailing Address - Phone:215-667-8883
Mailing Address - Fax:
Practice Address - Street 1:1190 S BASCOM AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3545
Practice Address - Country:US
Practice Address - Phone:215-667-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical