Provider Demographics
NPI:1285186668
Name:FATHI, DARIUSH (PSYD)
Entity Type:Individual
Prefix:
First Name:DARIUSH
Middle Name:
Last Name:FATHI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5113
Mailing Address - Country:US
Mailing Address - Phone:203-969-0802
Mailing Address - Fax:203-316-9024
Practice Address - Street 1:141 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5113
Practice Address - Country:US
Practice Address - Phone:203-969-0802
Practice Address - Fax:203-316-9024
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical