Provider Demographics
NPI:1659494177
Name:DASARI, MEENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEENA
Middle Name:
Last Name:DASARI
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 1:200 E 87TH ST
Mailing Address - Street 2:APT 12A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3112
Mailing Address - Country:US
Mailing Address - Phone:212-263-7312
Mailing Address - Fax:212-263-7806
Practice Address - Street 1:39 E 78TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0213
Practice Address - Country:US
Practice Address - Phone:917-734-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical