Provider Demographics
NPI:1487117891
Name:MADHAVAN, NIRUPAMA
Entity type:Individual
Prefix:
First Name:NIRUPAMA
Middle Name:
Last Name:MADHAVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7604
Mailing Address - Country:US
Mailing Address - Phone:425-749-8230
Mailing Address - Fax:
Practice Address - Street 1:5001 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-294-9891
Practice Address - Fax:844-564-4113
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60932675103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst