Provider Demographics
NPI:1437380045
Name:NABAVIAN, GUISSOO S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GUISSOO
Middle Name:S
Last Name:NABAVIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 BROADWAY
Mailing Address - Street 2:RM 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018
Mailing Address - Country:US
Mailing Address - Phone:212-840-8410
Mailing Address - Fax:212-840-8415
Practice Address - Street 1:1430 BROADWAY
Practice Address - Street 2:RM 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:212-840-8410
Practice Address - Fax:212-840-8415
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical