Provider Demographics
NPI:1457371205
Name:PERERA, GAYATHRI MARINI (PHD)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:MARINI
Last Name:PERERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14728 SATURN DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1347
Mailing Address - Country:US
Mailing Address - Phone:510-667-9199
Mailing Address - Fax:
Practice Address - Street 1:244 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6838
Practice Address - Country:US
Practice Address - Phone:510-667-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical