Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1194093641 |
---|---|
Provider Name | Dr. Kavita Mahesh Desai |
First Address | Minneapolis, MN 55408-4289 |
Second Address | Minneapolis, MN 55404-4543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2011 |
Last Update Date | 12/12/2011 |