Provider Demographics
NPI:1679586341
Name:DASS, BADRI (PHD)
Entity Type:Individual
Prefix:DR
First Name:BADRI
Middle Name:
Last Name:DASS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3819
Mailing Address - Country:US
Mailing Address - Phone:831-662-2632
Mailing Address - Fax:831-662-3462
Practice Address - Street 1:7435 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3819
Practice Address - Country:US
Practice Address - Phone:831-662-2632
Practice Address - Fax:831-662-3462
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical