Provider Demographics
NPI:1528395340
Name:ACHARYA, SURASREE (MA)
Entity Type:Individual
Prefix:MS
First Name:SURASREE
Middle Name:
Last Name:ACHARYA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ACHARYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:255 N SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3429
Mailing Address - Country:US
Mailing Address - Phone:626-696-1270
Mailing Address - Fax:
Practice Address - Street 1:255 N SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3429
Practice Address - Country:US
Practice Address - Phone:626-696-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health