Provider Demographics
NPI:1487022158
Name:PRAKASH, POOJA PRIYANKA (PHD)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:PRIYANKA
Last Name:PRAKASH
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 1:2280 DIAMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5750
Mailing Address - Country:US
Mailing Address - Phone:925-660-2036
Mailing Address - Fax:
Practice Address - Street 1:2280 DIAMOND BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5750
Practice Address - Country:US
Practice Address - Phone:925-660-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist