Provider Demographics
NPI:1609577584
Name:ERNAZATH-VENGALI, RAJALAKSHMY
Entity Type:Individual
Prefix:MS
First Name:RAJALAKSHMY
Middle Name:
Last Name:ERNAZATH-VENGALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 TOPPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2333
Mailing Address - Country:US
Mailing Address - Phone:908-456-6748
Mailing Address - Fax:
Practice Address - Street 1:140 CONSTITUTION WAY
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2964
Practice Address - Country:US
Practice Address - Phone:908-887-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst