Provider Demographics
NPI:1114226974
Name:NABIZADEH, PARASTOO F (PSYD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:PARASTOO
Middle Name:F
Last Name:NABIZADEH
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1700
Mailing Address - Country:US
Mailing Address - Phone:352-256-6996
Mailing Address - Fax:
Practice Address - Street 1:6816 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1700
Practice Address - Country:US
Practice Address - Phone:352-256-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-8006103K00000X
FLPY8731103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst