Provider Demographics
NPI:1003369646
Name:MIRAZIMY, MAHSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:MIRAZIMY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N MICHIGAN AVE STE 1530
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4000
Mailing Address - Country:US
Mailing Address - Phone:847-609-1475
Mailing Address - Fax:
Practice Address - Street 1:333 N MICHIGAN AVE STE 1530
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4000
Practice Address - Country:US
Practice Address - Phone:847-609-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical