Provider Demographics
NPI:1083076590
Name:NAZARABADI-GHOUCHANI, NEDA (MASTER OF EDUCATION)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:NAZARABADI-GHOUCHANI
Suffix:
Gender:F
Credentials:MASTER OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N CAMINO DEL OBISPO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6035
Mailing Address - Country:US
Mailing Address - Phone:520-342-9677
Mailing Address - Fax:855-462-3672
Practice Address - Street 1:4501 N CAMINO DEL OBISPO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6035
Practice Address - Country:US
Practice Address - Phone:520-342-9677
Practice Address - Fax:855-462-3672
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 222Q00000X
AZBEH-000364103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist