Provider Demographics
NPI:1215404439
Name:AFSARIFARD, KAYVON ADAM (MFTI)
Entity Type:Individual
Prefix:MR
First Name:KAYVON
Middle Name:ADAM
Last Name:AFSARIFARD
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WILDWOOD GDNS
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3831
Mailing Address - Country:US
Mailing Address - Phone:440-279-3525
Mailing Address - Fax:
Practice Address - Street 1:544 INTERNATIONAL BLVD APT 9
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2973
Practice Address - Country:US
Practice Address - Phone:510-444-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health