Provider Demographics
NPI:1831572924
Name:VAITHESWARAN, SUJATA (PHD, IMFT)
Entity type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:
Last Name:VAITHESWARAN
Suffix:
Gender:F
Credentials:PHD, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2195
Mailing Address - Country:US
Mailing Address - Phone:614-407-5964
Mailing Address - Fax:614-859-0727
Practice Address - Street 1:3 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2195
Practice Address - Country:US
Practice Address - Phone:614-407-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.1800072106H00000X
OHM.1400031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid