Provider Demographics
NPI:1306909270
Name:DEVADASAN, PUSPARANI (MFT)
Entity type:Individual
Prefix:MS
First Name:PUSPARANI
Middle Name:
Last Name:DEVADASAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2417
Mailing Address - Country:US
Mailing Address - Phone:415-750-5125
Mailing Address - Fax:415-386-2048
Practice Address - Street 1:2020 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1128
Practice Address - Country:US
Practice Address - Phone:415-750-5125
Practice Address - Fax:415-386-2048
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38BF3Medicaid