Provider Demographics
NPI:1609105063
Name:BHAT, JYOTHSNA SRIDHARAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHSNA
Middle Name:SRIDHARAN
Last Name:BHAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:JYOTHSNA
Other - Middle Name:
Other - Last Name:BHAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:35101 ELM CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-5209
Mailing Address - Country:US
Mailing Address - Phone:213-609-8732
Mailing Address - Fax:
Practice Address - Street 1:22 S STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3507
Practice Address - Country:US
Practice Address - Phone:267-991-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical