Provider Demographics
NPI:1740317254
Name:GANGULY, ANINDITA (PHD)
Entity type:Individual
Prefix:
First Name:ANINDITA
Middle Name:
Last Name:GANGULY
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 1:28125 BRADLEY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2288
Mailing Address - Country:US
Mailing Address - Phone:951-309-2140
Mailing Address - Fax:951-309-2141
Practice Address - Street 1:28125 BRADLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2288
Practice Address - Country:US
Practice Address - Phone:951-309-2140
Practice Address - Fax:951-309-2141
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical