Provider Demographics
NPI:1720156714
Name:SRINIVASAN, DIMPLE THAWANI (MA)
Entity Type:Individual
Prefix:MS
First Name:DIMPLE
Middle Name:THAWANI
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DIMPLE
Other - Middle Name:
Other - Last Name:THAWANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:7155 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1130
Mailing Address - Country:US
Mailing Address - Phone:858-300-0460
Mailing Address - Fax:858-300-0461
Practice Address - Street 1:3635 RUFFIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1880
Practice Address - Country:US
Practice Address - Phone:858-300-0460
Practice Address - Fax:858-300-0461
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist