Provider Demographics
NPI:1922235126
Name:SUBASH, PRIYANKA SUPARNA
Entity Type:Individual
Prefix:MISS
First Name:PRIYANKA
Middle Name:SUPARNA
Last Name:SUBASH
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 1:6 MAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3084
Mailing Address - Country:US
Mailing Address - Phone:508-813-8644
Mailing Address - Fax:
Practice Address - Street 1:385 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7304
Practice Address - Country:US
Practice Address - Phone:508-830-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS90901762101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor