Provider Demographics
NPI:1952167587
Name:JAYASEKARAN, MANONMANI
Entity Type:Individual
Prefix:MS
First Name:MANONMANI
Middle Name:
Last Name:JAYASEKARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CALVERT DR APT F203
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3754
Mailing Address - Country:US
Mailing Address - Phone:626-354-5414
Mailing Address - Fax:
Practice Address - Street 1:175 CALVERT DR APT F203
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3754
Practice Address - Country:US
Practice Address - Phone:626-354-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist