Provider Demographics
NPI:1316679467
Name:WILLOW ANXIETY AND OCD
Entity type:Organization
Organization Name:WILLOW ANXIETY AND OCD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKATDAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-667-8883
Mailing Address - Street 1:28 CORTEZ RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3246
Mailing Address - Country:US
Mailing Address - Phone:650-274-9595
Mailing Address - Fax:
Practice Address - Street 1:431 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5319
Practice Address - Country:US
Practice Address - Phone:215-667-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)