Provider Demographics
NPI:1083384580
Name:DESAI, ANAND (PSYD)
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1829
Mailing Address - Country:US
Mailing Address - Phone:630-640-4242
Mailing Address - Fax:
Practice Address - Street 1:1221 S CLARKSON ST STE 417
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1611
Practice Address - Country:US
Practice Address - Phone:630-640-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist