Provider Demographics
NPI:1063900017
Name:KANNAN, MADELEINE JANAKI (LCSW)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:JANAKI
Last Name:KANNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-8508
Mailing Address - Country:US
Mailing Address - Phone:650-498-2336
Mailing Address - Fax:
Practice Address - Street 1:866 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-8508
Practice Address - Country:US
Practice Address - Phone:650-498-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1115101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical