Provider Demographics
NPI:1245340652
Name:COUTTS, SANJI MARISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:SANJI
Middle Name:MARISSA
Last Name:COUTTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SANJI
Other - Middle Name:
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1663 DOMINICAN WAY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065
Mailing Address - Country:US
Mailing Address - Phone:831-462-1761
Mailing Address - Fax:831-462-4936
Practice Address - Street 1:1663 DOMINICAN WAY
Practice Address - Street 2:SUITE 214
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065
Practice Address - Country:US
Practice Address - Phone:831-462-1761
Practice Address - Fax:831-462-4936
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17944103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53869Medicare UPIN
CAOPL179440Medicare ID - Type Unspecified