Provider Demographics
NPI:1144577479
Name:KANEEZA LAFIR PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:KANEEZA LAFIR PSYCHOLOGICAL SERVICES INC
Other - Org Name:KANEEZA LAFIR PSYD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-522-1042
Mailing Address - Street 1:12006 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4119
Mailing Address - Country:US
Mailing Address - Phone:562-773-3044
Mailing Address - Fax:562-929-0516
Practice Address - Street 1:12006 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4119
Practice Address - Country:US
Practice Address - Phone:562-773-3044
Practice Address - Fax:562-929-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP192380OtherLICENSE NUMBER
CACP19238Medicaid