Provider Demographics
NPI:1457509689
Name:PATHAK, SHIRANI M (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRANI
Middle Name:M
Last Name:PATHAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24813
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95154-4813
Mailing Address - Country:US
Mailing Address - Phone:408-502-6790
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSS AVE STE 308
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3039
Practice Address - Country:US
Practice Address - Phone:408-502-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 281531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical