Provider Demographics
NPI:1952166514
Name:RASWANT, AMBIKA (MS MFT)
Entity Type:Individual
Prefix:MS
First Name:AMBIKA
Middle Name:
Last Name:RASWANT
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:RASWANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS MFT
Mailing Address - Street 1:PO BOX 41037
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160-1037
Mailing Address - Country:US
Mailing Address - Phone:408-806-0854
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 815E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5056
Practice Address - Country:US
Practice Address - Phone:323-332-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist