Provider Demographics
NPI:1619917887
Name:KASIRAJ, JAYANTHI MEENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:MEENA
Last Name:KASIRAJ
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 1:2708 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-7107
Mailing Address - Country:US
Mailing Address - Phone:916-485-5500
Mailing Address - Fax:916-734-6652
Practice Address - Street 1:2708 LATHAM DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864
Practice Address - Country:US
Practice Address - Phone:916-485-5500
Practice Address - Fax:916-734-6652
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical