Provider Demographics
NPI:1275409203
Name:PENUBARTHI, VISHNU SRAVYA
Entity type:Individual
Prefix:
First Name:VISHNU SRAVYA
Middle Name:
Last Name:PENUBARTHI
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 1:448 ECHO PASS
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2748
Mailing Address - Country:US
Mailing Address - Phone:737-663-7150
Mailing Address - Fax:
Practice Address - Street 1:448 ECHO PASS
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-2748
Practice Address - Country:US
Practice Address - Phone:737-663-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker