Provider Demographics
NPI:1063736742
Name:VARDARAJAN, ASHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:
Last Name:VARDARAJAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEST ST
Mailing Address - Street 2:SUITE 26E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1094
Mailing Address - Country:US
Mailing Address - Phone:646-525-9671
Mailing Address - Fax:
Practice Address - Street 1:10 WEST ST
Practice Address - Street 2:SUITE 26E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1094
Practice Address - Country:US
Practice Address - Phone:646-525-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical