Provider Demographics
NPI:1295215549
Name:SANTHIRASEGARI, JOSEPHINE MARGARET
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:MARGARET
Last Name:SANTHIRASEGARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20845 E CALORA ST APT B1
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1317
Mailing Address - Country:US
Mailing Address - Phone:626-251-7368
Mailing Address - Fax:
Practice Address - Street 1:540 S EREMLAND DR STE E
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3186
Practice Address - Country:US
Practice Address - Phone:626-966-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026461101YM0800X, 103TC0700X, 101YM0800X
CA116807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical