Provider Demographics
NPI:1467622498
Name:GHATE, BHARGAVI SHILEDAR BAXI (LICSW)
Entity Type:Individual
Prefix:
First Name:BHARGAVI
Middle Name:SHILEDAR BAXI
Last Name:GHATE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 134
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3041
Practice Address - Country:US
Practice Address - Phone:612-360-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN136971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical