Provider Demographics
NPI:1619450384
Name:MUKHERJEE, ANUJA DIVATIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANUJA
Middle Name:DIVATIA
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4758
Mailing Address - Country:US
Mailing Address - Phone:610-755-9342
Mailing Address - Fax:
Practice Address - Street 1:2 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4758
Practice Address - Country:US
Practice Address - Phone:610-755-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017879103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty