Provider Demographics
NPI:1508282179
Name:BAKSI-BANERJEE, MAITRAYEE
Entity Type:Individual
Prefix:
First Name:MAITRAYEE
Middle Name:
Last Name:BAKSI-BANERJEE
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 1:338 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1590
Mailing Address - Country:US
Mailing Address - Phone:408-636-8583
Mailing Address - Fax:
Practice Address - Street 1:338 STONEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1590
Practice Address - Country:US
Practice Address - Phone:408-636-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS293791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical