Provider Demographics
NPI:1265818306
Name:MOTTAHEDEH, DAHLIA LAUREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAHLIA
Middle Name:LAUREN
Last Name:MOTTAHEDEH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DAHLIA
Other - Middle Name:LAUREN
Other - Last Name:DANESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:SUITE 907
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-481-1664
Mailing Address - Fax:
Practice Address - Street 1:60 MADISON AVE
Practice Address - Street 2:SUITE 907
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1600
Practice Address - Country:US
Practice Address - Phone:212-481-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020662103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent