Provider Demographics
NPI:1043000896
Name:SUBRAMANIAN, LALITHA (PHD)
Entity type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11208 GERANIUM DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0844
Mailing Address - Country:US
Mailing Address - Phone:214-430-1156
Mailing Address - Fax:
Practice Address - Street 1:5900 S LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2193
Practice Address - Country:US
Practice Address - Phone:972-645-3940
Practice Address - Fax:972-645-3941
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1876978103TS0200X
NJ1164271103TS0200X
TX39449103TC2200X
ZZA39840103TC0700X
TX72901103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical