Provider Demographics
NPI:1508804931
Name:MOOKERJEE, INDRANI (MA MSW LCS WC)
Entity Type:Individual
Prefix:MS
First Name:INDRANI
Middle Name:
Last Name:MOOKERJEE
Suffix:
Gender:F
Credentials:MA MSW LCS WC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:PSYCH ASSOCIATES OF MARYLAND LLC
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:7130 MINSTREL WAY
Practice Address - Street 2:22
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-290-6940
Practice Address - Fax:410-290-9763
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSWL058451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705BPSOtherBCBS
MDN513Medicare ID - Type Unspecified