Provider Demographics
NPI:1215034863
Name:MUKHERJEE, ASHA K (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:K
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 LANCASTER LN N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1700
Mailing Address - Country:US
Mailing Address - Phone:763-553-7820
Mailing Address - Fax:763-383-0598
Practice Address - Street 1:4205 LANCASTER LN N
Practice Address - Street 2:SUITE 107
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1700
Practice Address - Country:US
Practice Address - Phone:763-553-7820
Practice Address - Fax:763-383-0598
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
167287OtherCOMPSYCH ID NO.
TAX ID NO.OtherFIRST HEALTH
46702MUOtherBLUECROSSBLUESHIELD ID
6166758OtherUNITED BEH. HEALTH
136932OtherUCARE PROV. ID
102142OtherLIFERA PROV ID NO.
TAX ID NO.OtherUNITED HEALTHCARE
TAX ID NO.OtherHORIZON BEHAVIORAL SRVCS.
990991020058OtherPREFD ONE & CIGNA ID
TAX ID NO.OtherFRIST HEALTH PROVIDER
TAX ID NO.OtherMATRIX PSYCH SERVICES
TAX ID NO.OtherTRICARE (CHAMPUS)