Provider Demographics
NPI:1699512384
Name:VENKATARAMAN, KAPILA ETHENMOO (MFT)
Entity type:Individual
Prefix:MS
First Name:KAPILA
Middle Name:ETHENMOO
Last Name:VENKATARAMAN
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:PO BOX 3169
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95055-3169
Mailing Address - Country:US
Mailing Address - Phone:408-337-2264
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPISI WAY STE 350
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2349
Practice Address - Country:US
Practice Address - Phone:408-337-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health