Provider Demographics
NPI:1467974543
Name:GOKHALE, ANUSHKA SONIA
Entity Type:Individual
Prefix:
First Name:ANUSHKA
Middle Name:SONIA
Last Name:GOKHALE
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 1:10 BALI LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4640
Mailing Address - Country:US
Mailing Address - Phone:908-268-7531
Mailing Address - Fax:
Practice Address - Street 1:3205 OCEAN PARK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3239
Practice Address - Country:US
Practice Address - Phone:310-488-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CA33499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist