Basic Information
| Provider Information | |||||||||
| NPI: | 1831406156 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEMPARATHY | ||||||||
| FirstName: | AYSHA BRIDGETH | ||||||||
| MiddleName: | AUGUSTINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O.BOX # 20428 | ||||||||
| Address2: | |||||||||
| City: | EL SOBRANTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103677309 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 ADELINE ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947032407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106010203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2010 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFTI 73480 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 108561 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.