Provider Demographics
NPI:1962934398
Name:CHARATHRAM, VASAVI
Entity type:Individual
Prefix:
First Name:VASAVI
Middle Name:
Last Name:CHARATHRAM
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 1:847 E LAUREL OAK DR
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2614
Mailing Address - Country:US
Mailing Address - Phone:626-808-4039
Mailing Address - Fax:
Practice Address - Street 1:415 W ROUTE 66 STE 202
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97515106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist