Provider Demographics
NPI:1205861507
Name:HALAVY GALDJIE, FARNAZ MARGO (PSY D)
Entity Type:Individual
Prefix:
First Name:FARNAZ MARGO
Middle Name:
Last Name:HALAVY GALDJIE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:
Other - Last Name:GALDJIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12400 WILSHIRE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1040
Mailing Address - Country:US
Mailing Address - Phone:310-266-6395
Mailing Address - Fax:310-442-0307
Practice Address - Street 1:12400 WILSHIRE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1040
Practice Address - Country:US
Practice Address - Phone:310-266-6395
Practice Address - Fax:310-442-0307
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP17835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP17835Medicare ID - Type Unspecified
P79354Medicare UPIN