Provider Demographics
NPI:1144763236
Name:HEJABIAN, ROYA
Entity Type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:HEJABIAN
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 1:999 FOREST AVE
Mailing Address - Street 2:#7
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3366
Mailing Address - Country:US
Mailing Address - Phone:207-536-1590
Mailing Address - Fax:207-536-1591
Practice Address - Street 1:999 FOREST AVE
Practice Address - Street 2:#7
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3366
Practice Address - Country:US
Practice Address - Phone:207-615-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical