Provider Demographics
NPI:1104653013
Name:NISHA SUNDARARAJ, LLC
Entity type:Organization
Organization Name:NISHA SUNDARARAJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:401-660-3168
Mailing Address - Street 1:1 RICHMOND SQ STE 333W
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5156
Mailing Address - Country:US
Mailing Address - Phone:401-660-3168
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 333W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5156
Practice Address - Country:US
Practice Address - Phone:401-660-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty