Provider Demographics
NPI:1821579079
Name:MUKHOPADHYAY, SUDDHA I (BCBA)
Entity Type:Individual
Prefix:
First Name:SUDDHA
Middle Name:
Last Name:MUKHOPADHYAY
Suffix:I
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ECHO PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4832
Mailing Address - Country:US
Mailing Address - Phone:213-425-4324
Mailing Address - Fax:
Practice Address - Street 1:2001 ECHO PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4832
Practice Address - Country:US
Practice Address - Phone:213-425-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst