Provider Demographics
NPI:1225367006
Name:DADLANI, MAMTA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:B
Last Name:DADLANI
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 1:1569 SOLANO AVE # 207
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2116
Mailing Address - Country:US
Mailing Address - Phone:305-389-1971
Mailing Address - Fax:
Practice Address - Street 1:1435 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1828
Practice Address - Country:US
Practice Address - Phone:305-389-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical