Provider Demographics
NPI:1912196445
Name:THARAYIL, PRIYA ROSE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:PRIYA
Middle Name:ROSE
Last Name:THARAYIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 E. BRIER DR., SUITE 200
Mailing Address - Street 2:CHILDREN YOUTH COLLABORATIVE SERVICES, DBH
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0002
Mailing Address - Country:US
Mailing Address - Phone:909-501-0700
Mailing Address - Fax:
Practice Address - Street 1:658 E. BRIER DR., SUITE 200
Practice Address - Street 2:CHILDREN YOUTH COLLABORATIVE SERVICES, DBH
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0002
Practice Address - Country:US
Practice Address - Phone:909-501-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical