Provider Demographics
NPI:1326781782
Name:JAVID, MAHDIEH
Entity Type:Individual
Prefix:
First Name:MAHDIEH
Middle Name:
Last Name:JAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:
Other - Last Name:JAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2111 SAN PABLO AVE.
Mailing Address - Street 2:P.O. BOX 2171
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702
Mailing Address - Country:US
Mailing Address - Phone:510-319-2990
Mailing Address - Fax:
Practice Address - Street 1:533A CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2511
Practice Address - Country:US
Practice Address - Phone:510-319-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist