Provider Demographics
NPI:1467198036
Name:MAHARAJ, OMRITA PRASAD
Entity Type:Individual
Prefix:MRS
First Name:OMRITA
Middle Name:PRASAD
Last Name:MAHARAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:OMRITA
Other - Middle Name:DOROTHY
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 EXPEDITION WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95832-1263
Mailing Address - Country:US
Mailing Address - Phone:916-752-4856
Mailing Address - Fax:
Practice Address - Street 1:2101 EXPEDITION WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95832-1263
Practice Address - Country:US
Practice Address - Phone:916-752-4856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD8979062103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst