Provider Demographics
NPI:1134136864
Name:PRIYADARSHAN, DEEPA NIRANJANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEEPA
Middle Name:NIRANJANA
Last Name:PRIYADARSHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 WATER FALL CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3256
Mailing Address - Country:US
Mailing Address - Phone:610-831-1582
Mailing Address - Fax:
Practice Address - Street 1:2091 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3211
Practice Address - Country:US
Practice Address - Phone:610-970-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty