Provider Demographics
NPI:1760925259
Name:HARIPRASAD, JAYA
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:
Last Name:HARIPRASAD
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 1:4626 S WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4410
Mailing Address - Country:US
Mailing Address - Phone:314-330-0617
Mailing Address - Fax:
Practice Address - Street 1:4626 S WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4410
Practice Address - Country:US
Practice Address - Phone:314-330-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor