Provider Demographics
NPI:1568954113
Name:PILLAY, SITA-MARIE KALYANI (PSYD, MA)
Entity Type:Individual
Prefix:DR
First Name:SITA-MARIE
Middle Name:KALYANI
Last Name:PILLAY
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6107
Mailing Address - Country:US
Mailing Address - Phone:650-207-6257
Mailing Address - Fax:
Practice Address - Street 1:6851 COLD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PENNGROVE
Practice Address - State:CA
Practice Address - Zip Code:94951-9722
Practice Address - Country:US
Practice Address - Phone:707-779-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34840103T00000X
CAPSB94027271103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist