Active NPI
Manju Prabadaran
- School Psychologist
- Fremont, CA
National Provider Identifier
1003637307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 220108394
- Practice address
- 4210 Technology Dr
Fremont, CA 94538-6337 - Phone
- (747) 777-2791
- NPI assigned
- Oct 18, 2024
- Last updated
- Oct 18, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 220108394 | CA | Primary |
Addresses
Primary practice location
4210 Technology Dr
Fremont, CA 94538-6337
Mailing address
2111 Essex St
Berkeley, CA 94705-1814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 220108394 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729209600000",
"number": "1003637307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2111 ESSEX ST",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4210 TECHNOLOGY DR",
"city": "FREMONT",
"state": "CA",
"postal_code": "945386337",
"telephone_number": "747-777-2791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRABADARAN",
"first_name": "MANJU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-18",
"last_updated": "2024-10-18",
"certification_date": "2024-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "220108394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.