Provider Demographics
NPI:1144236936
Name:SAIDIAN, BAHAREH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BAHAREH
Middle Name:
Last Name:SAIDIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BAHAREH
Other - Middle Name:
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4472
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:90290
Mailing Address - Country:US
Mailing Address - Phone:323-919-5191
Mailing Address - Fax:714-641-0334
Practice Address - Street 1:2900 BRISTOL STREET
Practice Address - Street 2:SUITE G 201
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-474-7389
Practice Address - Fax:714-641-0334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22985104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker