Provider Demographics
NPI:1821704529
Name:PRABHU, SHRADDHA ARIVIND
Entity Type:Individual
Prefix:DR
First Name:SHRADDHA
Middle Name:ARIVIND
Last Name:PRABHU
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 1:840 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-3123
Mailing Address - Country:US
Mailing Address - Phone:814-431-4553
Mailing Address - Fax:
Practice Address - Street 1:3104 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2820
Practice Address - Country:US
Practice Address - Phone:814-431-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker