Provider Demographics
NPI:1093193963
Name:FARSHCHIAN, LEILA
Entity Type:Individual
Prefix:MISS
First Name:LEILA
Middle Name:
Last Name:FARSHCHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2316
Mailing Address - Country:US
Mailing Address - Phone:201-777-4557
Mailing Address - Fax:
Practice Address - Street 1:246 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2316
Practice Address - Country:US
Practice Address - Phone:201-777-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01031275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst