Provider Demographics
NPI:1346650488
Name:GOLSHANNEJAD, MAZIAR (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MR
First Name:MAZIAR
Middle Name:
Last Name:GOLSHANNEJAD
Suffix:
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 E 5TH ST APT 6G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6914
Mailing Address - Country:US
Mailing Address - Phone:347-385-5904
Mailing Address - Fax:
Practice Address - Street 1:1685 EAST 5TH STREET APT 6G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:347-385-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NY001920-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health