Provider Demographics
NPI:1326497496
Name:SUBRAMANIAN, SUJATHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:
Last Name:SUBRAMANIAN
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 1:1 W 64TH ST
Mailing Address - Street 2:COURTYARD OFFICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6734
Mailing Address - Country:US
Mailing Address - Phone:917-538-9496
Mailing Address - Fax:
Practice Address - Street 1:1 W 64TH ST
Practice Address - Street 2:COURTYARD OFFICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6734
Practice Address - Country:US
Practice Address - Phone:917-538-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014199-1103G00000X, 103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis