Provider Demographics
NPI:1750448676
Name:SUNDARARAJAN, LOUISE L (EDD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:L
Last Name:SUNDARARAJAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:KUEN WEI
Other - Middle Name:L
Other - Last Name:SUNDARARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:691 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5244
Mailing Address - Country:US
Mailing Address - Phone:585-461-0995
Mailing Address - Fax:585-241-1650
Practice Address - Street 1:691 FRENCH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5244
Practice Address - Country:US
Practice Address - Phone:585-461-0995
Practice Address - Fax:585-241-1650
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01241827Medicaid
NY01241827Medicaid