Provider Demographics
NPI:1750629010
Name:PATEL, KAJAL R
Entity Type:Individual
Prefix:
First Name:KAJAL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 HAMMOND BUSINESS PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3666
Mailing Address - Country:US
Mailing Address - Phone:919-899-6259
Mailing Address - Fax:
Practice Address - Street 1:3040 HAMMOND BUSINESS PL
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3666
Practice Address - Country:US
Practice Address - Phone:919-899-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006919104100000X
SC88791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker