Provider Demographics
NPI:1558737502
Name:SUBRAMANIAM, GAYATRI (LMFT)
Entity Type:Individual
Prefix:
First Name:GAYATRI
Middle Name:
Last Name:SUBRAMANIAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3074
Mailing Address - Country:US
Mailing Address - Phone:408-771-5812
Mailing Address - Fax:
Practice Address - Street 1:21710 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1172
Practice Address - Country:US
Practice Address - Phone:408-771-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist