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Individual
MR. SURESH CHACKO
Active
Individual
MR. SURESH CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PSY29416
CA
Other
Enumeration date
03/26/2013
Last updated
08/05/2021
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