Provider Demographics
NPI:1003448408
Name:FARHADZADEH, AMY HAMIDEH (P:HD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:HAMIDEH
Last Name:FARHADZADEH
Suffix:
Gender:F
Credentials:P:HD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5085
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91308-5085
Mailing Address - Country:US
Mailing Address - Phone:818-749-1008
Mailing Address - Fax:
Practice Address - Street 1:22736 VANOWEN ST STE 103B
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2666
Practice Address - Country:US
Practice Address - Phone:818-749-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty