Provider Demographics
NPI:1396384335
Name:DAVODI FAR, MARYAM (DPA, MHA, MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:DAVODI FAR
Suffix:
Gender:F
Credentials:DPA, MHA, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 STATE ST APT 219
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5638
Mailing Address - Country:US
Mailing Address - Phone:858-525-3704
Mailing Address - Fax:
Practice Address - Street 1:3885 STATE ST APT 219
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5638
Practice Address - Country:US
Practice Address - Phone:858-525-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT108127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist