Provider Demographics
NPI:1649504259
Name:BAWARI, TRIPTI (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRIPTI
Middle Name:
Last Name:BAWARI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 W 11TH ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3821
Mailing Address - Country:US
Mailing Address - Phone:877-834-0587
Mailing Address - Fax:
Practice Address - Street 1:672 W 11TH ST
Practice Address - Street 2:SUITE 317
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3821
Practice Address - Country:US
Practice Address - Phone:877-834-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22725103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical