Provider Demographics
NPI:1225805229
Name:TIKKU, PRIYADARSHINI (LMHC)
Entity Type:Individual
Prefix:
First Name:PRIYADARSHINI
Middle Name:
Last Name:TIKKU
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PRIYADARSHINI
Other - Middle Name:
Other - Last Name:RAINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 BROAD ST STE B206
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2565
Mailing Address - Country:US
Mailing Address - Phone:781-693-3200
Mailing Address - Fax:844-439-7801
Practice Address - Street 1:43 BROAD ST STE B206
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2565
Practice Address - Country:US
Practice Address - Phone:781-693-3200
Practice Address - Fax:844-439-7801
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional