Provider Demographics
NPI:1619693934
Name:HARI SRINIVASA
Entity Type:Organization
Organization Name:HARI SRINIVASA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-641-0444
Mailing Address - Street 1:2036 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6439
Mailing Address - Country:US
Mailing Address - Phone:318-641-0444
Mailing Address - Fax:318-614-6118
Practice Address - Street 1:2036 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-6439
Practice Address - Country:US
Practice Address - Phone:318-641-0444
Practice Address - Fax:318-614-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty